Preamble

The House met at half-past Nine o'clock

PRAYERS

[MADAM SPEAKER in the Chair]

PETITIONS

Local Authority Tenants

Mrs. Anne Campbell: I wish to present a petition from 500 local authority tenants who reside in the city of Cambridge in my constituency. Their concern is
That Section 105 of the Housing Act 1985, part of the original Tenants Charter of the Housing Act 1980, gives a most important right to council tenants in England and Wales in that it obliges their landlord authority to consult them on matters of housing management.
The right of tenants to be consulted and to have their views taken into account when any subsequent decision is made is the foundation for tenant participation in housing management.
Wherefore your Petitioners pray that your honourable House: Will instruct the Government to make no amendment to reduce tenants' rights under Section 105, Housing Act 1985 (1985 c. 68) and to therefore strike out Clause 114(2) of the Housing and Urban Development Bill, published on Thursday, 22nd October 1992, and strike out clause 115(1) of the Bill insofar as it concerns the proposed amendment made in Section 27(AA)4 of the 1985 Act.

To lie upon the Table.

Treaty of Maastricht (Referendum)

Mr. Tony Benn: I present the second group of petitions signed by many tens of thousands of people from all over the United Kingdom who are in favour of and opposed to the Maastricht treaty and represent a wide range of political opinion. The petitioners state:
That the provisions of the Maastricht Treaty, which was negotiated by the heads of Government of the member states within the European Community, are designed to bring about a European Union, complete with its own constitution, in which all the countries that are party to it, will belong; That this union, and its laws, will have a profound effect upon the way in which the United Kingdom is governed, and upon the democratic rights of the citizens of this country to elect and remove those who now enact and administer the laws of this nation".
The main point of the petition is
That the British people have been given no right to determine, for themselves, in a democratic vote, whether or not they wish these constitutional changes to be made".
The Petition ends in the traditional way:
Wherefore your petitioners pray that your honourable House: Will ensure that before the Maastricht Treaty, or any modification or amendment of it, is approved by Parliament, or ratified by Her Majesty's Government, the citizens of the United Kingdom shall be given the right to vote for, or against, that Treaty, in a National Referendum, and that the decision reached in that Referendum be accepted as binding upon the Government and Parliament.
And your petitioners, as in duty bound, will ever pray etc.

To lie upon the Table.

Orders of the Day — Osteopaths Bill

Order for Second Reading read.

Mr. Malcolm Moss: I beg to move, That the Bill be now read a Second time.
It is a singular privilege for me to have a double opportunity this morning, first to present a private Member's Bill but especially to present such an important piece of legislation which will not only enhance dramatically the professional status of the osteopathic profession but will be a milestone on the road to recognition for complementary medicine as a whole.
I begin by thanking the King's Fund and its working party, and in particular Simon Fielding, who has been a great help to me in the past few months. I am glad that he is present today. I thank officials from the Department of Health, who have given me every assistance possible, and Lord Walton, whose Bill I have taken over because his original Bill fell in the Lords earlier this year. I thank hon. Members of all parties who have supported the Bill, and I especially thank Opposition Members who will speak in its support today.
Some consternation was expressed to me just before Christmas when it was discovered that I was about to embark on a week's skiing with the Lords and Commons ski team. There was the prospect either that I would be standing here with one or more limbs in plaster or that I would be flat on my back, which would not have been the most auspicious circumstances in which to present the Bill.
Osteopathy is a system of diagnosis and treatment which lays its main emphasis on the structural and mechanical problems of the body. It is not regarded as an alternative to conventional medicine, but rather as a complementary therapy, offering patients an additional option in the treatment of certain conditions affecting the body's mechanical functions.
Osteopathic treatment predominantly comprises gentle manual methods. It utilises a diagnostic procedure similar to conventional medical examination, but it pays especial attention to the patient's musculo-skeletal system. Osteopathy is the most widely used of the complementary therapies. I am sure that many hon. Members have availed themselves of the services of an osteopath at some time, and many are here today to support the Bill.
It is estimated that there are now well over 2,000 osteopaths practising in the United Kingdom, and that they are visited by 100,000 patients every week. Given its growing popularity and widespread use, it is of key importance that there should also be safeguards for the public which will ensure, for example, adequate clinical training for all those who are entitled to call themselves osteopaths.
An essential element of the training is to equip practitioners with the ability to recognise conditions for which osteopathic treatment is inappropriate and cases in which the patient should be referred to a registered medical practitioner. The final essential component of the safeguards needs to be the provision of effective disciplinary procedures to ensure that the profession achieves and maintains the very highest standards.
I was encouraged in my decision to take the Bill forward by the support now given by the medical profession to osteopaths in their quest for statutory registration. For some time, the British Medical Association has accepted that there is
'an organised, reputable and coherent body of knowledge underlying osteopathic practice".
The BMA has also stated its belief that the increasing practice of cross-referral between general medical practitioners and osteopaths has been of immense benefit to patients.
The support has not always been so warm. Until the mid-1970s, doctors were prevented from referring patients to any practitioner who was not medically qualified. I very much welcome the change of heart which is demonstrated by the increasing interest of doctors in osteopathy, and by an increasing willingness to refer patients to osteopaths. There is also a growing public interest in a variety of complementary therapies, not least osteopathy, which leads me to believe that the Bill is very timely.
The Bill is modelled on the recommendations for statutory regulation presented in the report by the King's Fund working party on osteopathy, which were enshrined in the Bill presented by Lord Walton of Detchant in the previous Session. I know that the osteopathic profession would wish to join me in paying tribute to the King's Fund working party—and especially to its chairman, Sir Thomas Bingham—for its considerable contribution in advancing the cause for statutory regulation of osteopaths.
I appreciate that, at first glance, the similarity between my Bill and Lord Walton's may not be evident. That is primarily because the two pieces of legislation were penned by different hands. However, I can assure the House and the profession that both the fundamental principles and the key purposes of the two Bills are identical. The first purpose is to establish a representative governing body for osteopaths and the second is to set in place a fair and practical system of statutory regulation for the profession.

Mr. Michael Stern: I welcome the legislation, and especially the part to which my hon. Friend has just referred. Does he agree that a professional body in medicine established now has an opportunity to set new standards for such professional bodies simply by being newly established and by not carrying with it the bag and baggage of some of the older professional bodies in medicine, which have sometimes seemed over-protective of their members?

Mr. Moss: The Bill breaks new ground in setting standards of regulation that have not yet been met by some of the other medical groups. I hope that my hon. Friend the Member for Bristol, North-West (Mr. Stern) will realise as I continue my speech that a great deal of thought has gone into the Bill, not only to make it a landmark for future legislation to encompass more medical groups, but to incorporate in it some clauses that existing medical groups that have regulation may want to take up at a later date.
I also assure the House that the Bill encapsulates the recommendations for initial registration made in the working party's report to enable, as far as possible, osteopaths in current practice to qualify for registration.

The Bill also extends the provisions to enable certain other practitioners who might not otherwise have been able to meet the conditions for registration to be registered.
I shall explain in greater detail later the different ways in which practitioners will be able to qualify for registration. I have mentioned the point now about extending eligibility to illustrate not only how the Bill is firmly rooted in the working party's recommendations, but how it builds on that solid foundation. That reflects the input in policy from across government, the experiences of similar statutory schemes such as the General Medical Council, our European obligations, competition laws and aspects of human rights.
The primary object of the Bill is to set in place a professionally led, statutory registration scheme for osteopaths. It would be similar to those existing for many other professional groups, including all the key health professionals. The scheme would be achieved primarily through the establishment of a General Osteopathic Council, which would have the statutory responsibility to develop, to promote and to regulate the profession of osteopathy throughout the United Kingdom, and to set educational standards and standards of professional conduct.
The Bill would also establish four statutory committees of the General Osteopathic Council. The first would be the education committee, which would have the responsibility of promoting high standards of education in osteopathy and of providing the general council with advice on all matters concerning education, training and examinations in osteopathy. The three other committees would be the investigating committee, the professional conduct committee and the health committee, which collectively would provide the fitness-to-practise machinery.
The three committees would provide the key function of ensuring that an allegation made against an osteopath concerning his professional conduct or competence to practise was properly investigated and dealt with effectively. The committee's remit would also cover allegations that a practitioner had been convicted of a criminal offence, or that he or she was unfit to practise for reasons of ill health.
The statutory scheme would replace the current system of voluntary regulation. That has worked exceptionally well for the majority of practitioners, and it has played a key role in paving the way for statutory regulation. However, by its very nature, a voluntary system is unable to enforce standards of competence or conduct. If a practitioner chooses not to participate in the scheme, the regulatory body is completely powerless to exercise any jurisdiction over that individual's practice.
That fundamental weakness brings into sharp focus the need for the statutory scheme. As the law stands, anyone can call himself or herself an osteopath and set up in practice. There is no obligation to undergo any formal training or to comply with standards of professional competence. Members of the public therefore have no guarantee that a person holding himself out as an osteopath is properly qualified and competent to do so. The only recourse that patients have in the event of mishap is through the common law.
Under my Bill, the system of voluntary regulation would be replaced by a single statutory body capable of enforcing standards of training, education, proficiency and professional conduct throughout the profession in the United Kingdom. The body would also have powers to


require anyone wishing to practise as an osteopath to conform to those standards, be registered with the statutory council and submit himself to its authority. The statutory council would thus have the unique ability to unite the profession and sweep aside the current fragmentation.
The achievement of statutory regulation would, I believe, herald the dawn of an exciting new era for the osteopathic profession. It is essential, however, that, in reaching out for the prize of tomorrow, the profession does not let go the trophies that it holds today.
I have mentioned that the current systems of voluntary registration have provided the solid foundation for a statutory scheme, but, even assuming the successful passage of the Bill, it could take up to two years before the machinery to drive the statutory scheme is fully in place. I therefore urge individuals in the profession, many of whom are here today, not to abandon the current schemes prematurely. The successful transition to statutory regulation will depend heavily on their continued support and maintenance.
I emphasise that the statutory scheme would be not only led but regulated by the profession. For that reason, 12 of the proposed 24 members of the General Osteopathic Council would be osteopaths elected by the profession itself. Eight of the remaining members would be non-osteopaths, appointed by the Privy Council. Those members would represent wider interests and, in particular, the views of patients. That would help to increase the breadth of experience within the general council and ensure that the profession had a firm and balanced basis on which to develop in future.
The other four members of the general council would include a person with experience in medical education, nominated by the Secretary of State, and three members appointed by the education committee to represent the interests of training institutions in the United Kingdom. The balance of different members is mirrored in all other statutory regulatory schemes; the scheme, like all its counterparts, would be overseen by the Privy Council.
Eagle-eyed Members may have spotted an omission from the Bill—there are no arrangements for establishing the very first General Osteopathic Council. It is not possible for the arrangements currently in the schedule to apply to the first general council because, at the start of the scheme, there will be no registered osteopaths to be elected or to vote. Special transitional arrangements will therefore need to be provided, and I propose to specify them in an amendment to the schedule in Committee.
What I have in mind is that the initial osteopathic and lay members of the general council would be appointed by the Privy Council. That is in keeping with the practice followed in the establishment of other statutory schemes, and was endorsed by the working party in its report.
To ensure that the general council reflects a balance of good professional opinion, experience and practice, the initial osteopathic members would, of course, be appointed after consultation with those bodies that administer the current scheme of voluntary registration. The individuals would not, however, be representatives of any particular organisation—nor would they be beholden to any sectoral interests. Instead, they would be selected on the basis of their individual ability and merit and would, in effect, be ambassadors for the profession as a whole.
The working party on osteopathy regarded the primary objective of any scheme of regulation to be the benefit and protection of patients. Having studied statutory schemes governing other professions, the working party concluded:
'for all practical purposes there is no viable alternative to the statutory registration of osteopaths which should be open to inspection by members of the public.
That view was supported by all the organisations consulted by the working party, and I hope that it will be supported by the House today.
A statutory register of osteopaths would therefore form the core of the regulatory scheme. The register would be maintained by the registrar appointed by the general council. In future, all practitioners wishing to call themselves osteopaths would be required to be registered on the register. That requirement would be backed up by a provision in the Bill making it a criminal offence for an unregistered practitioner to use that title or any variation of it.
The closure of professional title was one of the key recommendations in the working party report. It is also a central provision of the Bill. I emphasise, however, that the offence will be related to the use of the title "osteopath". The Bill does not in any way seek to prohibit the use of osteopathic techniques by other manipulative therapists such as physiotherapists, or prevent them from telling their patients that they are using such techniques.
That brings me to the nub of the scheme—the proposed criteria for registration, which will clearly be of central concern to many people, not least those in the profession itself. As this is such a crucial part of the regulatory scheme, I should like to explain in detail the different categories of registration proposed under the Bill—and, in particular, the transitional arrangements that would apply.
Application for registration would be on a strictly individual basis. Membership of a particular professional body would not, therefore, confer any automatic right or advantage on an individual, although it is, of course, intended that the statutory scheme should embrace, so far as is practicable, practitioners currently registered under the system of voluntary registration.
The Bill provides for the "full" and "conditional" registration of existing practitioners. That is based on the recommendations made in the working party report, although "conditional registration", as referred to in the Bill, is what the working party called "provisional registration". The different title that we have selected more accurately reflects the conditional nature of that category of registration, and also offers the profession scope to introduce a more familiar system of provisional registration, along the lines of pre-registration for doctors, if it so wishes.
Entitlement to full registration is founded on the same principles of good character, qualification and experience as outlined in the working party's report. The provisions are intended to enable as many osteopaths in current practice as possible to qualify for registration, without compromising the key principle of providing the public with adequate and effective safeguards against inexperienced and untrained practitioners.
The Bill does, however, impose an additional requirement: practitioners would also have to be in good physical and mental health. A similar provision exists in the Dentists Act 1984. The intention is to enable the registrar at the outset to refuse registration to an applicant


whose known state of health raises serious doubts about his ability to practise. Without such a provision, the registrar might have no other option but to register the practitioner and hope that he would be able to secure an early suspension of the osteopath's registration by immediately referring the matter to the health committee.
For an initial two-year transitional period, commencing on the day on which the register opens, a practitioner who does not hold a qualification recognised by the general council as one that equips him or her with the standards of education and training required for the safe and competent practice of osteopathy may still be entitled to full registration. That would be on the basis that he or she can satisfy the registrar that, for at least five of the preceding seven years, he or she has spent a substantial part of his or her working time in the safe, lawful and competent practice of osteopathy.
That arrangement follows the working party's recommendation and acknowledges that experienced practitioners who may not have the benefit of a properly structured course of training but who have been practising safely and competently in the name of osteopathy for many years should be brought within the scope of the regulatory scheme.
The Bill does, however, require that such practice should have been "lawful". That provision has been included so that the General Osteopathic Council is not, say, placed under an obligation to register an overseas practitioner on the basis of what might have been illegal practice in his home country. Conditional registration would be simply a transitional arrangement, with applications for that category of registration being permitted only during the two-year transitional period which I mentioned a few moments ago. I have already said that conditional registration is modelled closely on the working party's recommendations for provisional registration.
The purpose of conditional registration is to enable registration of practitioners who do not hold a recognised qualification, and who are unable to muster the five years out of seven safe, lawful and competent practice of osteopathy required for full registration. It is not in any way intended to create a two-tier system of registration, but was recommended by the working party as a mechanism to ensure that as many practitioners as possible are included under the Act.
Practitioners who are registered with conditional registration would fall into two categories. The first will be those who just fail to meet the five years out of seven criterion for full registration. Those practitioners will be eligible for full registration if they have spent a substantial part of their working time in the safe, lawful and competent practice of osteopathy for a total of four years out of the six years preceding the opening of the register. In addition, they may be required to undergo a test of competence and give an undertaking that, within a specified period, which would not exceed five years from the opening of the register, they will complete any further training and acquire such additional experience as specified by the registrar. I should add that, if a practitioner were found to be fully competent in the skills

and knowledge required for full registration, no additional training would be specified, and he would be able to apply to have his registration suitably converted.
I said that the grounds under which practitioners will be able to qualify for registration had been extended to include a group that might not otherwise have been eligible. To be more accurate, practitioners in that group were more likely to have fallen between two stools. It had been assumed that all qualifications would be either recognised or rejected for recognition. On that basis, if a practitioner were told that his qualification was not a recognised one, he could still hope to qualify for registration on the strength of current or recent practice if an application were made within the two-year transitional period.
As a result of representations made to me, it became evident that practitioners may possess qualifications from an institution that has perhaps ceased to exist and that they may not have been in current or recent practice—because, for example, they have been bringing up their family or caring for sick or elderly relatives. Such practitioners face a potentially no-win situation.
On the one hand, the general council and the education committee might not have been able to find sufficient information about the qualification to decide whether it should be recognised. On the other, the practitioner might have no means of being able to satisfy the practice criteria for registration. Such practitioners will therefore be unable to get on the register unless they obtain another recognised qualification, although they may be perfectly competent. Although that group is expected to comprise only a small number of individuals, the Bill now extends the provisions of conditional registration so as not to exclude them.
Consequently, practitioners who are unable to satisfy the practice criteria for either full or conditional registration will still be eligible for conditional registration if they hold a qualification for osteopathy that has not been refused recognition, although it is not a recognised qualification. Practitioners who qualify for registration on those grounds will be subject to the same conditions of further training and acquiring the additional experience which I described earlier.

Dr. Liam Fox: I wonder whether my hon. Friend could clarify one point. Is it intended that osteopaths will be required to carry professional indemnity cover during the preliminary period?

Mr. Moss: I thank my hon. Friend for raising that point, which I shall come to later in my speech. It is an important part of the Bill, and I will explain its ramifications later.

Mr. Toby Jessel: On such an important Bill, which affects the welfare of millions of our fellow citizens who suffer from back pain, is my hon. Friend aware that there are no less than 16 hon. Members present in the House but only two Opposition Members, although it is Friday? Does that not show that Conservative Members have a much greater interest than Labour Members in such an important Bill?

Mr. Moss: I am not sure whether that comment means that Conservative Members have a greater interest in such matters, or that they suffer more from back pain.
I have referred several times to recognised qualifications. I am aware that feelings of uncertainty exist in


certain quarters about how that aspect of the scheme will operate. It may help if I begin with the European dimension. European Community qualifications will automatically be recognised by virtue of enforceable Community rights or obligations.
The recognition of other qualifications will depend on whether the General Osteopathic Council, in consultation with its education committee, considers that such qualifications meet the standards of education, training and proficiency specified by the general council for the safe and competent practise of osteopathy. To ensure that such decisions will be impartial, no qualification will be afforded recognition until the general council has sought and secured the consent of the Privy Council.
While I am on the subject of professional education, I should mention that, although it will be the responsibility of the education committee to satisfy itself that those schools whose qualifications have been recognised continue to meet the required standards of proficiency, it will not be for the committee or the General Osteopathic Council to prescribe how the curriculum is taught.
Diversity of approach stimulates innovation. In medical schools, considerable differences in emphasis exist for specific elements of the curriculum and the way in which they are taught. However, they all produce safe and competent doctors. Therefore, it is essential that a similar diversity be allowed to flourish under the osteopaths statutory scheme.
The newest category of registration is provisional registration. As I have already mentioned, care must be taken not to confuse provisional registration as provided in the Bill with the concept of provisional registration set out in the working party's report and Lord Walton's Bill in the last session.
An initial year of supervised practise is rapidly becoming the norm in a growing number of professional groups. It offers practitioners the advantages of being able to widen gradually their field of experience, especially in the running of a practice, and have the support and advice of more experienced colleagues readily available.
I appreciate that provisional registration does not exist in the profession's current system of voluntary registration. However, it may be one which the profession would wish to adopt in time. One of the disadvantages of a statutory scheme is that, once it is set in place, it can subsequently prove to be difficult to amend. Therefore, I have tried to provide now for the future.
The provision in the Bill is an enabling one. It will give the general council the necessary scope to introduce a system of provisional registration at a later date if it so chooses and after it has consulted the profession and provided Parliament with an opportunity to scrutinise its proposals.

Mr. Andrew Hunter: Can my hon. Friend expand his arguments and explain why he decided not to incorporate in his Bill the requirement of a provisional registration state as opposed to leaving the option open for the future if the council chooses to implement it?

Mr. Moss: Initially, we felt that the Bill incorporated a great number of different clauses which advanced the progress and tightness of the regulations. It was important to get the basics on the statute book, introduce conditional registration, which is a new idea, and make provision to enable the profession to introduce the provisional category

at a later date if it so chooses. It is questionable whether the profession can accommodate the changes in one go during the early period—certainly the transitional period. It is much more sensible to get the basics in place and then allow the profession to move in a direction which it so chooses at its own pace.
Provisional registration will apply for the initial year of registration. During that time, osteopaths will be permitted to practise only under the supervision of a fully registered osteopath. For many practitioners, that will coincide with their first postgraduate year. However, the provisions in the Bill are sufficiently broad to include practitioners who are returning to the profession after an absence of some years—because, for example, they have been bringing up a family—and those who are applying for registration for the first time. Again, that is recognised as good practice among many professions and is a matter which the general council may wish to consider if and when it ever decided to go down this road.
Before leaving the subject of registration, I should like briefly to mention three other matters. My hon. Friend the Member for Woodspring (Dr. Fox) raised a point about professional indemnity insurance. That was considered by the working party to be of such key importance in securing better protection for patients that it recommended that such insurance should be held as a condition of registration. Unfortunately, making that a statutory requirement could distort the otherwise free workings of the insurance market, potentially to the detriment of both insurers and osteopaths.
In order to square that circle, the Bill would empower the General Osteopathic Council through its rules of registration to require professional indemnity insurance to be held by practising osteopaths. The general council would also have the power to check that a practitioner had renewed his cover at the appropriate time and, most importantly, to initiate disciplinary proceedings in cases where he had not.
Linking the need to hold insurance with the right to practise would give osteopaths who have retired or are taking time out to bring up a family the possibility of maintaining their registration without having to take out what would otherwise be unnecessary insurance cover.
The second matter is post-registration training. The working party recommended that a practitioner's continued registration should be made subject to him or her satisfactorily completing post-graduate training or refresher courses. In that way, members of the public could be assured that practitioners were keeping up to date with the latest techniques and developments in their field. That is one of the many areas in which the working party's recommendations broke new ground in the realm of professional self-regulation.
However, the working party also recognised that that recommendation could not be introduced immediately, because the profession's training and education resources would need to be devoted to existing practitioners who will hold conditional registration during the first few years of the scheme.
In order to avoid the need to make a specific amendment to the Act at a later date, clause 16 of the Bill will permit the General Osteopathic Council to introduce a scheme of post-registration training in the future if the profession so wishes. However, once again, the general council would first be required to consult the profession and, in this case, any other parties that it might think


appropriate, such as other groups of health care professionals. The council would also have to obtain the consent of the Privy Council and give Parliament an opportunity to scrutinise the detail of its proposals before it could introduce such a scheme.
The third postscript on registration involves fraudulent registration. The Bill contains a provision similar to section 39(1) of the Medical Act 1983 to enable the general council to erase from the register the name of a practitioner who obtained registration by fraudulent means. However, the register would have in addition to that power, the power to impose an immediate suspension of a practitioner's registration while the allegation was being investigated, if he was satisfied that such action was necessary for the protection of members of the public.
I hope that the House will agree that all the provisions to which I have referred would form a fair and just system of registration and would provide the cornerstone of a statutory scheme. They seek to bring as many bona fide practitioners of osteopathy as possible within its scope. That is not only of key importance to practitioners but would benefit the public, as it is far better to have all the practitioners of a profession governed by a single statutory body capable of enforcing appropriate standards of practice.
The other essential component of the regulatory scheme is a mechanism to ensure that high standards of professional conduct and competence are maintained and that members of the public are not put at risk by practitioners who are unfit to practise for reasons of ill health. That would be provided by the General Osteopathic Council's investigating, professional conduct and health committees. Broadly speaking, those comittees would perform the same function as their counterparts in other schemes. Allegations would initially be considered by the investigating committee. They would then be referred, as appropriate, to the professional conduct or health committee for further investigation and action. However, I should like to highlight some important differences in the powers that the committees would be able to exercise—differences which illustrate yet again where the osteopaths scheme would break new ground.
For the first time under any statutory scheme governing the health professions, professional incompetence would be specifically identified as a trigger point for disciplinary investigation. I know that other professional groups—in particular the medical profession—are considering the introduction of a similar concept for its members. Their solutions may be different, but the osteopaths can take justifiable pride in being the first health care profession to make the concept an integral part of its statutory scheme.
Another matter on which the osteopaths scheme scores a first is the breadth of the powers of the professional conduct and health committees to take immediate action to suspend an osteopath's registration where they considered such action to be necessary for the protection of members of the public. The power proposed for the investigating committees—the ability to impose an immediate suspension of up to two months—would be similar to that exercised, for example, by the General Medical Council's equivalent committee.
However, for the first time, the professional conduct and health committees would be able to impose their own

suspension where they considered such action to be necessary to protect members of the public and to do so before they investigated the allegation. Although likely to be exercised only rarely, the power might be used, for example, where the allegation made against an osteopath was also the subject of a series criminal investigation. In such a case, the professional conduct committee might choose to defer its proceedings until after the criminal proceedings had been dealth with. In a similar way, the health committee might decide that an allegation about an osteopath's health was such that he or she posed an obvious and definite risk to his or her patients.
In making provisions for those powers, the Bill also ensures that the practitioner's rights are protected. For example, before a suspension order could be imposed, a practitioner would first have to be given an opportunity to appear before the relevant committee to state why he or she considered such action to be unnecessary. The pratitioner would be entitled to be legally represented at such a hearing and would have an additional right of appeal to the courts.
Like their counterparts in other statutory schemes, the professional conduct and health committees would be able to suspend an osteopath's registration or impose conditions on his or her right to practise if they determined that the allegation against him or her was proven. The professional conduct committee would in addition be able to admonish the osteopath or order his name to be erased from the register.
Another first for the osteopaths scheme is the proposal to give the professional conduct committee the explicit power to impose conditions on an osteopath's right to practise following a period of erasure. As the Bill reinforces the powers of fitness-to-practise committees in those ways, the public will be able to exercise the utmost confidence in the statutory scheme and be assured that it affords them the highest level of protection of any of today's regulatory schemes.
I have mentioned briefly that the Bill makes provision to safeguard the human rights of osteopaths. That is of key importance. I can assure the House and the profession that great care has been taken to ensure that the panoply of appeal provisions within the Bill are founded firmly on the principles of natural justice and reflect European law on human rights. In that way, members of the profession can likewise be fully confident that the statutory scheme would rigorously protect their interests and be one in which they can take justifiable pride.
I mentioned that, in keeping with other statutory schemes, the work of the General Osteopathic Council and its four statutory committees would be overseen by the Privy Council. In the unlikely event that the council failed to perform its functions under the Act, the Privy Council would have the power to direct it to perform any of its functions that the Privy Council considered that it had failed to fulfil. As a final resort, the Privy Council would be able to step in and take over the functions of the council and do anything that it could have done under the Act.
Let me end where I began. Due to the sterling work of the working party on osteopathy, the profession has a well thought out and carefully structured scheme that reflects the most up-to-date thinking on professional self-regulation. I hope that the House and the profession will agree that the proposals will not only provide the means to enable the profession to control its destiny and set its future direction but secure better patient protection,


safeguard the interests of the public and provide a model for other statutory self-regulatory schemes for the 1990s and beyond.

Dr. Ian Twinn: I must declare an interest as I am one of two parliamentary advisers to the Chartered Society of Physiotherapy.
I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on introducing the Bill. Although I do not suffer from back pain—having voted for the Maastricht measures so far—I suspect that many of our colleagues may well need the services of professions that specialise in the manipulative therapies, something of which the Conservative Front Bench is only too well aware.
The Chartered Society of Physiotherapy is supportive of the moves by its sister profession to introduce regulation. There are estimated to be about 2,000 osteopaths, the Chartered Society of Physiotherapy has 24,000 members and there are about 700 chiropractors, which demonstrates that at least three professions are intimately involved with such work.
Physiotherapists work in hospitals and in private practice and about a third of their number are actively involved with the manipulation of the back and the neck. Among physiotherapists there is a view that it would have been better for the three professions to come together for regulation rather than moving separately, but that does not mean that the Bill is not welcome.
There is a substantial overlap between osteopaths, chiropractors and physiotherapists, and the latter do everything that osteopaths can do and considerably more.
Physiotherapists are regulated by the Professions Supplementary to Medicine Act 1960, which is now rather out of date. It was introduced when physiotherapists principally worked in hospitals and doctors prescribed their work for them. Their regulatory framework is therefore seriously outmoded and needs to be updated. For that reason, I believe that the King's Fund rejected using the 1960 Act for the regulation of osteopaths and that there is now a case for the urgent revision of that Act.
The Bill will introduce modern, regulatory structures for osteopaths and we should like those provisions to be extended to physiotherapists as soon as possible. We congratulate the osteopaths on achieving the Bill. As my hon. Friend the Member for Cambridgeshire, North-East said, it will be the first profession to have that modern structure, which is very welcome.
There is concern that the protection in clause 29 of the title osteopath might lead to problems for other professions, including medical practitioners and physiotherapists, as it might prevent such professions from claiming to use osteopathic techniques. My hon. Friend may wish to return to that subject in Committee so that there may be a clear understanding that other professions are already using such techniques and that they should not be prevented from making such a claim although they are not osteopaths. A comment on that subject from my hon. Friend the Minister would also be welcome.
Title protection is to be given to osteopaths, but the title of physiotherapist is not protected and anyone can practise as such or claim to be a physiotherapist. Only the terms "state registered physiotherapist" or "chartered physiotherapist" are protected by the 1960 Act, so the Chartered

Society of Physiotherapy looks at the Bill with some envy and would like equal protection to be given to the short titles of all the professions involved. If that could be achieved it would be in the public interest.
My hon. Friend the Member for Cambridgeshire, North-East mentioned the disciplinary procedures in the Bill, which are very welcome. Physiotherapists feel that they do not have sufficient powers to discipline their own profession or, for example, to investigate the claims of overseas practitioners in physiotherapy. Again, he is setting out procedures that will be helpful to the profession and we should like that to be reflected in the Minister's remarks.
I thank my hon. Friend the Member for Cambridgeshire, North-East and the working party of osteopaths for their work. I urge all the professions practising such techniques to get together so that we can set down new regulations for them all as soon as possible, as that will be in the public interest.

Ms. Liz Lynne: I extend my support and that of my party to the Bill, which is a most welcome response to the King's Fund report on osteopathy and the subsequent Bill that was introduced by Lord Walton in another place in December 1991. I also thank the hon. Member for Cambridgeshire, North-East (Mr. Moss) for his work thus far on the Bill. I hope that he steers it through the House to a successful conclusion.
Osteopathy came to Britain at the turn of the century and the first attempt to put it on a statutory footing was in 1931. Just over 60 years later it looks as if we shall at last be successful—another fine example of the British Parliament responding rapidly to new ideas and changing circumstances.

Lady Olga Maitland: I thank the hon. Lady for her comments on the Bill, and must add to her reflections about its popularity. A MORI poll has shown that osteopathy is the most popular complementary medicine, and 63 per cent. of those polled were very satisifed and only 9 per cent. dissatisfied.

Ms. Lynne: I am grateful to the hon. Lady. Osteopaths responded to Parliament's inaction by establishing registering bodies and it is to their credit that the profession is among the leading advocates of statutory regulation.
The Bill is of particular importance, as it represents the first statutory recognition of the role of complementary medicine in the health of the nation. I hope and expect it to become a model for future Bills.
It is well known that the Chiropractic Advancement Association is hoping for official regulation soon after the Bill is enacted. Initially, it was thought that chiropractors could be included in the Bill introduced in December 1991. The Government have given some indications that they might soon be recognised, but I am a little concerned about the statement by Baroness Hooper, in a Lords debate on complementary medicine in May 1990, that an appropriate level of maturity is required on the part of the relevant professions before legislation would be considered. I should have thought that when professions are immature they can do the most harm and that that is when they need the most regulation. While I recognise the practical difficulties of proceeding along the path of


regulation too soon, I hope that the Government will take a more active role to bring the various complementary therapies into a statutory framework.
The key points in the Bill are those dealing with the registration and education of osteopaths. Both aspects of the Bill are greatly to be welcomed. I am particularly pleased about the proposal that the General Osteopathic Council may require osteopaths to have further training after registration.
While it is clear that only accredited qualifications will be acceptable, and that educational establishments will have independent assessors, the Bill does not state that such establishments will be accredited. That would seem to be a logical extension of the existing proposals and it might clear up any confusion for anyone wishing to train as an osteopath.
In addition to my general comments, I have some specific remarks to make on the Bill. The Bill contains no definition of osteopathy. Only after detailed consultation was it decided that there were sufficient differences between osteopathy and chiropractic for them not to be covered by the same Bill. A definition is important because, without it, I cannot see how an effective code of practice can be established.
I should like the general council that the Bill will establish to ensure that, in drawing up the code of practice, there are the widest possible consultations with users of the service and their representatives. Once produced, the code of practice should be made easily available to members of the public, preferably free or via public libraries, but, if necessary, at a reasonable cost as stated in the Bill. The Bill does not say whether a "reasonable" cost is reasonable in the view of the council or the user.
I naturally agree with the establishment of a register of osteopaths, but, as in the case of the code of practice, the register should be easily available for inspection. The Bill allows for that to happen, but does not say where the register will be available, although I assume that it may be at the general council's offices. Perhaps consideration should be given to making it available at major libraries. I should also like to see a provision in the Bill or a declaration from the general council stating that osteopaths must display their registration at their place of work and clearly indicate their category of registration.
There should also be further protection for prospective patients. Last year in the United States, for instance, guidelines for quality assurance and practice were laid down. The document that was produced ran to some 200 pages. In particular, it was recommended that practitioners provide a written diagnosis for the patients and tell them what to do if the treatment does not work in two weeks and when to ask for a second opinion. In addition, particular emphasis should be placed on making it clear to patients how a complaint should be made.
With so many functions proposed in the Bill, I am concerned that the general council may not have enough resources to carry them all out effectively. I presume that the council is expected to be self-financing and I am therefore a little worried that it may have difficulties performing all its tasks. Experience in America, where legislation has been in place for more than 20 years, is that

practitioners do not have the time or training to administer such a body effectively. I hope that that question will be dealt with in this country.
Could some light be shed on whether cranial osteopathy will be covered by the Bill? An article in The Guardian on 12 January says that there is some debate among osteopaths themselves about its value.
Despite the points that I have raised, the Bill is a major step forward and points the way for many complementary therapies. I urge all hon. Members to support it.

Mr. Toby Jessel: I must declare an interest as a patron of the National Back Pain Association, the headquarters of which is in Teddington in my constituency. I warmly congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on this excellent Bill. I wish it every success and I hope that it will go on to the statute book without delay. However, my hon. Friend's speech dealt largely with internal, structural and technical matters to do with the osteopathy profession. It was almost as if he had received a large amount of briefing from that profession. It is important for the House to see the wood as well as the trees with which he dealt so extensively. I know that he will not mind if I say that much of what he said was on Committee points.
The whole purpose of osteopathy is to relieve back pain in people. Osteopaths are not an end in themselves but a means to an end. Back pain is a scourge and a pestilence which afflicts millions of our fellow citizens, including the Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville), and myself.

Lady Olga Maitland: May I add to my hon. Friend's comments the fact that in 1979, 11.5 million working days were lost through back pain? That was a great loss to the country and cost our social security system enormous sums.

Mr. Jessel: I am grateful to my hon. Friend. I believe that the figure is even greater. The figure that I have seen is 230,000 people per working day. Multiplied by the number of working days, that comes to considerably more than 11.5 million. There is doubtless a substantial loss to the country in terms of days off work, and I believe that, proportionately, women are affected even more than men.
A huge amount of pain and discomfort is caused, but because the causes are complicated and it is not a "glamour" welfare cause such as a disease affecting children, heart attacks or cancer, which cause death—[Interruption] It is a little trying for me to have my hon. Friend the Member for Cambridgeshire, North-East carrying on a conversation just four yards away from me.
Because back pain affects such a large number of people and is not a "glamour" welfare cause afflicting children or resulting in death, it is difficult to get the body politic or the public generally to pay as much attention to it as it deserves, despite the large number of people whom it affects. That is why the debate on the Bill is welcome, even if it is somewhat narrow. I happen to go to a chiropractor and I think that they are at least as good as osteopaths, if not better. I am sorry that they could not be included in the Bill, but I hope that there will be as little delay as possible before a Bill is introduced on chiropractic.
The Government's White Paper, "The Health of the Nation", published last year, singled out five key areas for priority action: coronary heart disease and strokes; cancer; mental illness; AIDS; and accidents. However, the document also referred to five other candidates with a strong claim to key area status next: rehabilitation; the health of elderly people; asthma; drug misuse; and back pain. The inclusion of back pain in that list followed a meeting between Mr. Stanley Grundy CBE, founder of the National Back Pain Association, his director Dr. Mervyn Bryn Jones, Lord Joseph and myself with my right hon. Friend the Member for Bristol, West (Mr. Waldegrave), the Secretary of State for Health in the last Parliament. The meeting was to stress the great importance of back pain.
I hope that my hon. Friend the Under-Secretary of State will be kind enough to explain the position of that second grouping of five priority areas, and say what he thinks the Government can do to focus attention on it and to make progress as fast as possible in dealing with the scourge of back pain.
My hon. Friend the Minister has shown a tremendous interest in the problem of back pain, having attended and addressed the association's conference in central London last November. He has also seen Mr. Grundy several times, and I understand that my hon. Friend hopes, within his busy programme, to find time to visit the association's headquarters before long.
The association promotes research, whether by osteopaths, doctors, or chiropractors; it establishes branches throughout the country to promote interest in back pain, to provide means by which people can exercise, and to spread information; and it publishes educational material—such as a most useful recent manual for nurses on the correct way to lift patients. The national health service suffers a considerable loss of nurses' time when they hurt their backs lifting patients. I understand that 5,000 copies of that manual have already been sold.
Can my hon. Friend the Minister make it clear that general practitioners who are health service budget holders may use their budgets to refer patients both to osteopaths and to chiropractors? Will he also make clear the position in respect of value added tax on fees paid privately, whether under insurance policies or otherwise, both to osteopaths and to chiropractors? For many years the Department of Health has discussed that question with the Treasury, which decides in the light of legislation whether VAT should be attached to such fees. The Treasury has sought advice from the Department as to what is and is not deemed medical, because that affects whether or not VAT is applied. The Department has in turn referred the matter to a somewhat moribund body called the Council for Professions Supplementary to Medicine. The medical professions as well as the supplementary professions are represented on that council, and for years that body has put a stop on exempting osteopathy and chiropractic from VAT.

Mr. Moss: My hon. Friend has introduced a most important point. I wonder if he realises that osteopaths are obliged to charge VAT on their bills to patients while physiotherapists are not?

Mr. Jessel: I am grateful for my hon. Friend's clarification. It is nonsensical that physiotherapists approved by that council do not have to charge VAT while

osteopaths and chiropractors, who are not so approved, must do so. I hope that the Department will indicate that if the Bill becomes law it will draw that matter to the attention of the Treasury so that it can be reviewed without delay.
If the Bill is passed and osteopaths become, in the eyes of the law, members of a profession, I hope that it will not go to their heads. In Britain, professionalism has an up side and a down side. The up side is that members of any profession—barristers, solicitors, accountants, doctors or dentists—endeavour to uphold standards. The down side is that they become somewhat introverted, in that they care about one another's good opinion rather than that of the public. Barristers care mainly about the good opinion of other barristers, doctors about the good opinion of other doctors, and so on. They tend to assume that qualification, which is essential in any profession, is so all-important that nothing else much matters. It is thought that a person who is qualified must be good and one who is not qualified must be no good at all.
Professional qualification is a necessary condition, but it is not a sufficient condition for professional competence. It remains vital for any professional, if he or she is to be good at his or her work, to possess flair, zest, and insight, among other gifts. I hope that there will not be so much harping on professional qualifications to the extent that those other qualities are played down. That would not be in the interests of the public. I hope that osteopaths will regard their professional status as a means of improvement and not take it to mean that everything has now been done. It is only a step.

Mr. David Atkinson: I congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on his good fortune in the ballot and on his choice of Bill. I was grateful for his invitation to be a sponsor, because, as he knows, I am particularly interested in the greater recognition of another so-called complementary profession—chiropractic. From my personal experience and that of many of my constituents and others, I am as fully convinced of the benefits of chiropractic as I am of osteopathy. I am privileged to have the Anglo-European College of Chiropractic in my constituency, which I hope right hon. and hon. Members will visit.
Both osteopathy and chiropractic were founded in the belief that many everyday disorders are caused by spinal defects impeding the work of our immune system. I welcome the Bill not only for the undoubted benefits that it will bring to patients in the proper regulation, registration and, above all, recognition of osteopaths but because it will pave the way for a similar Bill for chiropractors, which the King's Fund working party will also draft—based on what we hope will be the successful outcome of this Bill. I hope that it will be taken on board by one of my ballot-lucky right hon. or hon. Friends in the next Session.
I take this opportunity to express my deep regret that the complementary professions have been denied recognition for so long because of the failure of successive Governments to pass appropriate legislation on their behalf. Instead, each of those professions is being advised to pursue its own Bill, such as that before us. That will take years, which I find totally unacceptable. I am certain that


any Government initiative to legislate for other uncontroversial complementary professions, given their ever-growing use and appreciation by patients—who find them successful where NHS-prescribed conventional surgery or drugs have failed—would be widely welcomed. Unfortunately, as my hon. Friend the Member for Twickenham (Mr. Jessel) implied, the so-called orthodox professions, as represented on the Medical Research Council and the Council for Professions Supplementary to Medicine, continue to withhold their sanction and support —thus sabotaging proper recognition of those who are properly qualified, to the detriment of patients.
In so doing, they are allowing unqualified cowboys and unscrupulous quacks to do untold damage to those members of the public who use them, and who find it extremely difficult to obtain legal redress. It is time to end that closed shop in the medical profession, which inhibits such competition.
I very much hope that my hon. Friend the Minister will stop sitting on the fence of Government neutrality towards the complementary professions. He could do that by renewing his Department's grant to the Research Council for Complementary Medicine; its recent termination is incomprehensible, given the enormous sums that are rightly spent on orthodox medical research and the amounts spent by other European Governments on research into complementary medicines. Moreover, the termination of the grant is contrary to the recommendations made some years ago by the Department's own working group on back pain.
My hon. Friend the Minister could also announce that the Government now intend to extend the Professions Supplementary to Medicines Act 1960 to include complementary medicines, and he could invite the research council to make appropriate recommendations to him. As my hon. Friend the Member for Twickenham pointed out, after 33 years there is now an overwhelming case for a review of the Act. Alternatively, my hon. Friend the Minister could announce a Government inquiry into the most popular complementary medicines, to subject them to scientific validation with the ultimate aim of integrating orthodox and complementary medicines. Such integration has already taken place in the Netherlands.
My hon. Friend the Member for Cambridgeshire, North-East has made an outstanding case for the benefits to patients that would undoubtedly result from the legislation. The statutory recognition of osteopaths would encourage more patients to use their services—especially now that fund-holding GPs can pay for them out of their own budgets: I commend the action taken last year by the Minister's predecessor, my hon. Friend the Member for Loughborough (Mr. Dorrell), to allow them to do so. The Bill will, I hope, encourage health authorities, hospital staff and doctors to work more closely with the osteopathic profession. As osteopathy, chiropractic and other such therapies do not require such expensive equipment as national health service treatment, and also do not require increasingly expensive drugs, their statutory recognition would result in enormous savings in the health service, despite patients having to bear the cost of treatment.
My hon. Friend the Member for Twickenham rightly enjoined the Minister to urge our right hon. Friend the Chancellor of the Exchequer to consider whether the cost of alternative treatment should be exempt from VAT.

Mr. William Cash: My hon. Friend and I have travelled down the path of complementary medicine for many years. Does he agree that the new arrangements for fund holders could be used to enable patients to receive the complementary and alternative treatment that they want through their local GPs? I believe that that is already happening to some extent. Appropriate arrangements could be set up with complementary and alternative practitioners.

Mr. Atkinson: That is still a back-door method. My hon. Friend and I have been working for years to try to bring about proper recognition of complementary medicine: I pay tribute to the work that has been done to enable Bills such as this—and, we hope, subsequent Bills —to establish such recognition. He was engaged in that work long before he became a Member of Parliament.
I hope that the Bill will also encourage companies to become more aware of the opportunities for them to refer employees to osteopaths or chiropractors. Widespread absenteeism resulting from back pain is costing the national economy an enormous amount. I am sure that if the Bill is passed, more and more operators of private health insurance schemes will be encouraged to reimburse subscribers for the cost of osteopathic treatment. I also believe that increasing use of osteopathy and other complementary treatments will lead to greater accuracy in the diagnosis of disorders that still baffle the NHS, such as allergies and ME.
I hope that the Bill will be given an unimpeded passage through both Houses. Let me again congratulate my hon. Friend the Member for Cambridgeshire, North-East—and Lord Walton on his pioneering work in introducing a similar Bill last year in the other place. I also pay tribute to the work of the King's Fund.
I hope that a similar Bill to deal with chiropractic will follow this one—or that, better still, the Government will present a Bill to give proper statutory recognition to all the complementary medical professions, for which an increasing number of our constituents are voting with their feet.

Mr. David Tredinnick: There is no doubt in my mind that, indirectly, I owe my seat in the House to the work of chiropractors and osteopaths. Fifteen years ago, I suffered an accident and broke three vertebrae in my back. Having lain in bed for several months, I was put back together by such practitioners, and I therefore owe them a particular personal debt.
I note with interest that other hon. Members—for instance, my hon. Friend the Parliamentary Under-Secretary of State and my hon. Friends the Members for Twickenham (Mr. Jessel), for Bolton, North-East (Mr. Thurnham) and for Edmonton (Dr. Twinn)—suffer from back problems. My hon. Friend the Member for Edmonton mentioned the impact of the European Communities (Amendment) Bill: having looked at next week's business, I think that hon. Members on both sides


of the House may need the services of osteopaths and chiropractors, but not every Conservative Member may agree with that.
Apart from the treatment that I received at the time of my accident, the treatment that I have received in subsequent years has been very important. My message to the public is that the disciplines of osteopathy and chiropractic can be enormously beneficial.
I also speak as treasurer of the all-party parliamentary group for alternative and complementary medicine. I pay tribute to my hon. Friend the Member for Stafford (Mr. Cash), who is sitting beside me on the Back Benches—

Mr. Cash: For ever.

Mr. Tredinnick: I had better not comment on that.
However, I pay tribute to my hon. Friend's work on alternative medicine, and to that of my hon. Friend the Member for Bournemouth, East (Mr. Atkinson). I believe that my hon. Friend the Member for Stafford and I were the only two Members of Parliament who attended the launch of the King's Fund by the Prince of Wales in December 1991. We were also involved in the attempt to take Lord Walton's Bill through the House of Commons; it fell at the last general election.
I welcome the Bill particularly because I think that it will shake out the tiny minority of charlatans in the profession. My hon. Friend the Member for Bournemouth, East referred to unqualified quacks, and there are certainly a few unscrupulous people around. The Bill will also provide an understandable framework, and will encourage the use of osteopathy to relieve the pain described by my hon. Friend the Member for Twickenham. I understand that he had an accident that hurt him quite badly, and he has probably suffered considerable pain over the past two weeks.
The Bill will also give confidence to people who were wondering how to solve their back problems. Only yesterday, I spoke to a senior Canadian Member of Parliament who suffers from muscular and skeletal pain. I asked him why he did not see an osteopath or chiropractor. He said, 'I am not sure about these people; they are not regulated."
That is the nub of the problem: if people were made confident by regulation, more of them would take advantage of such treatment. We have already heard from my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) about the large number of people who are attracted to osteopathy, and I believe that, with regulation, many more will follow.
In my experience, GPs have no great understanding of back problems unless they are specialists. A close supporter of mine in the general election campaign suddenly developed great back pain. She was advised to rest for two weeks, which was not possible during the campaign. She went to a osteopath who was a chiropractor, and within a day some relief had been given and she was back on the road.
Just after Christmas, my five-year-old daughter was acting out the part of a children's play with a big cushion on her head when she suddenly developed acute pain. She was checked by a doctor who, fortunately, found nothing serious. The doctor said, 'The problem will go away with time; children at this age are very resilient." I took her to an osteopath in Leinster square who was open on the Saturday after the new year, and two osteopaths kindly

treated her. She came away an hour later and has not mentioned that back pain again. Those are practical demonstrations of how people can benefit from such treatment.
Over the years, there has been a marked shift of opinion towards alternative and complementary medicine and osteopathy. In its 1986 report, the British Medical Association dismissed alternative medicine as a passing fashion. A number of surveys showed otherwise, and gradually medical opinion has shifted ground. For example, a 1986 Which? survey suggested that osteopathy was the most widely used complementary therapy, and 82 per cent. of patients interviewed claimed to have been cured or improved by the treatment.
Another Which? survey last November reported that each year one in four readers visited an alternative practitioner, which includes osteopathy—twice as many as the 1986 survey—and were highly satisfied. Four out of five users claim to have been improved or cured by alternative treatments; three out of four would use this form of treatment again.
Those findings confirm the results of the 1989 MORI survey, which revealed that 93 per cent. of users were satisfied with chiropractic treatment and 83 per cent. of users were satisfied with osteopathy. My hon. Friend the Member for Sutton and Cheam dropped 20 per cent. when she gave her figure. The figure that I have is 83 per cent., not 63 per cent. Some 80 per cent. were satisfied with homoeopathic treatment. The MORI survey showed that homoeopathy, osteopathy and acupuncture were the most widely used alternative medicines.

Mr. George Kynoch: My hon. Friend has used the term 'alternative medicine" several times. Does he intend to use the term 'complementary medicine"? Many of the forms of treatment that he has mentioned are complementary rather than alternative.

Mr. Tredinnick: My hon. Friend is absolutely correct. I have used the term 'alternative medicine" as the shortened version of 'alternative and complementary medicine". He will recall that I referred to the fact that I am treasurer of the all-party group for alternative and complementary medicine. There is a debate about what is alternative and what is complementary, but I certainly speak for both.
Last November's Which? survey quoted a study in which four out of five medical students said that they would like some form of alternative training incorporated into their course.
I argue that the Bill is not the end of a road but very much the beginning of a new relationship between alternative and complementary medicine, including osteopathy, and the health service. I am delighted to see my old and hon. Friend the Under-Secretary in his place on the Front Bench. [HON. MEMBERS: "Not too old."] I think that I can count him as an old friend; we have known each other for 25 years.
I firmly believe that the Bill is the start of a new relationship between alternative and complementary medicine and the health service. With the greater recognition and regulation that the Bill will give, it should be possible to achieve greater integration of the work of osteopaths and other alternative practitioners within the health service.
The previous Under-Secretary, my hon. Friend the Member for Loughborough (Mr. Dorrell), made a


significant contribution towards achieving that integration when he ruled in the last Parliament that GP fund holders could employ alternative practitioners, which of course includes osteopaths, if they took clinical responsibility. I hope that my hon. Friend the Under-Secretary will see fit to go further and make it possible for other general practitioners to use the services of alternative and complementary practitioners. I believe that that is very important. I tell my hon. Friend the Under-Secretary, in the presence of its chairman, my hon. Friend the Member for Stafford, that the all-party parliamentary group aims to achieve full integration of most of the various alternative disciplines in the health service.
The House will consider other Bills in the future. At one stage, chiropractors hoped that their work would be included in the Bill. The different schools of chiropractic, such as the McTimoney school and others, have taken tremendous strides towards bringing their disciplines together in an understandable framework.

Mr. David Atkinson: indicated assent.

Mr. Tredinnick: My hon. Friend the Member for Bournemouth, East nods in assent.
They have put their house in order, as requested by the Department, and I hope that the next Bill will be for chiropractors.
Other disciplines such as acupuncture may benefit from such regulation. My hon. Friend the Member for Edmonton referred to physiotherapy, which is important. In addition, there are disciplines such as aromatherapy. I have the largest factory of aromatherapy and essential oils and the largest practice in the world in my constituency. I opened its new premises yesterday. It used to work out of an attic in a disused hosiery factory, but it now has a splendid new building. It is training not only lay practitioners who express an interest but is teaching medical practitioners; nurses are being taught these skills. The work of aromatherapy is relevant to osteopathy because before treatment an osteopath can use oils such as roman chamomile, juniper berry, lavender and sweet marjoram to relax and warm up muscles.

Mr. Alan Duncan: Ooh, nice!

Mr. Tredinnick: I thought that my hon. Friend the Member for Rutland and Melton (Mr. Duncan) might find this amusing, but it is not amusing to someone suffering from pain.
My hon. Friend makes the point well: any hon. Member who had talked about osteopathy or chiropractory in the House 10 years ago would have been laughed at. I say to my hon. Friend the Member for Rutland and Melton, as I strike him with a rubber mallet, that these disciplines, which may seem a little weird to the majority, will eventually become mainstream.
Some say that by iridology, the study of the colours of eyes and shape of pupils, one can diagnose different ailments that affect the body. I venture to suggest that that and phrenology, the study of the shape and condition of the head, will eventually come within the scope of the health service.
My hon. Friend the Under-Secretary will find a tremendous opportunity to save costs if he pursues this route, because it has been found that alternative

practitioners who are medically qualified issue far fewer prescriptions. Furthermore, homoeopathic prescriptions are less expensive, and homoeopathic preparations are increasingly available in the huge number of homoeopathic shops that are bursting into bloom all over the country as a result of public demand. This move is market-led—I say that although I do not want to upset the hon. Member for Makerfield (Mr. McCartney), whom I have in the past seen stand on a bench to make a point.
The serious point to all this is that cost savings can be made, much happiness can be given, and many problems can be solved by alternative and complementary medicine, including osteopathy. I appeal to the House to take the alternative and complementary medicine much more seriously than it has been taken. I welcome the Bill, which is a major step forward. I pay tribute to my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss), and look forward to the successful passage of the Bill through all its stages.

Mr. William Cash: I join other hon. Members in congratulating my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) not only on promoting the Bill but on the way in which he has tackled the subject. Over the past nearly 20 years, I have been the legal adviser in relation to complementary and alternative medicine. I started in the days when, as my hon. Friend the Member for Bosworth (Mr. Tredinnick) said, one could not talk about it easily because people either did not know about it or thought that it was based on quackery, which it was not.
My hon. Friend the Member for Bournemouth, East (Mr. Atkinson) played an important part in the beginnings of the objective analysis of complementary medicine. He served on the Committee—which took evidence—that examined a private Bill, in which I also happened to be involved, back in about 1975. That Bill was aimed at driving acupuncturists out of business and was strongly attacked. My hon. Friend listened to the cross-examination of witnesses from both the medical profession and acupuncturists. The Committee unanimously concluded that the acupuncturists had a good case. I give that as an example of the way in which Parliament has helped to break down the barriers and I pay tribute to my hon. Friend and to other distinguished Members who have joined me in the all-party group on complementary and alternative medicine, of which I have the honour to be joint chairman with the right hon. Earl Baldwin of Bewdley. I should declare an interest in that I give continuing legal advice on these matters.
Let me also pay tribute to Simon Fielding, who is here in the House under the Gallery. I have known him for a long time and those who know about the Bill and the work that he has put into ensuring that osteopathy should be—

Mr. Deputy Speaker (Mr. Geoffrey Lofthouse): Order. I hesitate to interrupt the hon. Gentleman, but he has been here a long time and should be aware that he is not supposed to refer to people in the Gallery.

Mr. Cash: I have made my point, but I withdraw the reference on that basis.
I congratulate the Department on the way in which it has moved in relation to complementary and alternative


medicine. The atmosphere has changed greatly and much diligent and effective thinking has been given to those matters. I am delighted that my hon. Friend the Minister will be giving the Bill the additional support that it will require to ensure that it gets on to the statute book.
I have no intention or desire to go through all the points that have been made by my hon. Friends the Members for Cambridgeshire, North-East, for Bosworth, for Bournemouth, East, and for Twickenham (Mr. Jessel). However, I wish to get one or two points on the record because there has been a significant change in the policy on osteopathy over the past 20 years. Back in the mid-1970s, the BMA handbook said that doctors should have nothing to do with osteopaths because osteopathy was not a science. This was put in extremely strong language. The General Medical Council took a rather different view. The Bill is a testament to the work of osteopaths and demonstrates how attitudes in the medical profession have changed substantially in the past 20 years.
The BMA set up an inquiry seven years ago in which there was a general attack on complementary and alternative medicine. I tabled an early-day motion, which about 150 Members of Parliament supported, and we saw off that attack pretty well. I do not wish to cast aspersions on the medical peofession in this context because there has been a learning curve. There was bias, but there has been a significant change in the attitude of doctors towards osteopathy and other complementary therapies.
I intervened in the speech of my hon. Friend the Member for Bournemouth, East to speak about general practitioner fund-holding arrangements to which I strongly believe that serious attention should be given. We had an interesting meeting the other day with Baroness Cumberlege, the Parliamentary Under-Secretary of State for Health, in which some of those ideas were developed. We have already heard questions about whether grants could or should be made. The withdrawal of grant aid was not a sensible move, and I strongly opposed it. However, through the aegis of the Medical Research Council, further funds could and should be made available.
Osteopathy, along with chiropractic, acupuncture and herbal remedies, has to be taken seriously. Therefore, we must give those sectors a reasonable amount of help because they have nothing to fall back on. It is not as though they have the large funds of the Medical Research Council behind them. Those who know just how large those funds are will agree that reasonable help should be given, and my urgent plea is that it should be, because that would be in the interests of everybody, including the medical profession. My hon. Friend the Member for Kincardine and Deeside (Mr. Kynoch) is a doctor.

Mr. Kynoch: No.

Mr. Cash: I am sorry. I thought that my hon. Friend was a doctor.

Mr. Kynoch: I should declare my interest. My wife is a doctor. I am sure that my hon. Friend will agree that the medical profession has accepted osteopathy because it is seen as a complementary rather than, as it was portrayed years ago, an alternative medicine. Is not that an important point?

Mr. Cash: I agree. It is very important to stress that aspect, because there is a mutuality. Each can learn from

the other and there is a learning curve all round. The Bill represents the culmination of a great deal of hard work on that learning curve.
Important questions arise in relation to other member states of the European Community and their approach to these issues. If we pass an Act of Parliament, we should bear in mind that if there were an extension of competence in the Community to embrace health generally and that fell within the single market—as the herbal remedy question does at the moment—an application of article 100a through a directive could, in theory, override the provisions of the Bill.
I leave that point on the table for consideration. We must bear in mind the fact that we can work together in the European Community with other member states as we want to and not be disadvantaged, as might be the case if a regulation or directive of the type that I have described were to emerge. I exhort my hon. Friend the Minister, as he has a good nose for such things, to keep a watchful eye on that aspect of complementary and alternative medicine in its application to the United Kingdom.
I trust and believe that self-regulation in osteopathy is about to become a reality. My hon. Friend the Member for Cambridgeshire, North-East, all hon. Members involved in the exercise and everyone in the complementary field who has helped to push the Bill along deserve credit for what they have achieved.
We should remember what happened to George III around 1800 and the way that he was treated. By the 1840s and 1850s, things had begun to change. After the Medical Act 1858 was passed, huge arguments developed between different parts of the medical profession. Each side believed that it knew best. The lesson that we must learn from the way in which medicine has developed is that it must do so on an open and reasonable basis, learning from the complementary side as well as giving to it.
On that note, I strongly recommend that the Bill should reach the statute book. I congratulate everyone concerned and the Department on the helpful way in which they have accelerated the Bill's progress.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): On behalf of the Government, I also congratulate my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss) on his success in the ballot and on his choice of Bill. I begin by stating that the Government fully support the Bill and hope that it will also receive the support of the House.
Osteopathy was developed by an American doctor called Andrew Taylor Still and first came to Britain around the turn of the century. It was brought over by a group of American-trained practitioners who later formed the British Osteopathic Association. The first osteopathic training institution—the British School of Osteopathy— was founded in London in 1917 by Doctor J. Martin Littlejohn who had studied under Andrew Taylor Still.
Today, the medical profession regards osteopathy as truly complementary to the treatment provided by medical practitioners and one which enhances the range of possible treatment options available to patients. Given the increasingly common instances of cross-referral between general practitioners and osteopaths, it would not be


unusual these days for an osteopath to be treating a patient who is currently receiving medication from his or her doctor.
Each week, around 100,000 men and women from all walks of life and from across a wide section of the population consult an osteopath. About half of them do so because of low back pain. Of those, nearly 90 per cent. claim to be cured or to experience an improvement in their condition as a result of treatment.
However, the gentle manual manipulative techniques which comprise osteopathy have also proved to be effective in the treatment of tension headaches, neck and shoulder pains, for many types of joint strains such as in the wrists, elbows, knees, ankles and feet—indeed, anything to do with the biomechanics of the body and its mechanical functions.
For example, many women choose osteopathic treatment as an alternative to drugs for the relief of aches and pains and other discomforts often associated with pregnancy. Sportsmen and women often consult an osteopath following injuries or to help alleviate problems that have previously prevented them from performing at their best.
However, as my hon. Friend the Member for Cambridgeshire, North-East has already said, at the present time anyone can call himself or herself an osteopath and set up in practice. There is no obligation for practitioners to undergo formal training of any kind or to comply with any standards of professional competence or ethical practice. Members of the public, therefore, have no guarantee that a person calling himself or herself an osteopath is either properly qualified or competent in the practice of osteopathy or in the skills of differential diagnosis to know when osteopathy is inappropriate or when medical attention is more properly and, perhaps, more urgently required.

Mrs. Judith Chaplin: My hon. Friend the Minister has just said that it is important that there is a correct standard of qualification. Will he reconsider the way in which qualifications are supported by the Government? A constituent of mine gained a place to study physiotherapy for which her fees would have been paid under the mandatory award system. However, she also gained a place at the British School of Osteopathy where she would have received only £695 a year towards her fees. If we want the high standard of qualification necessary to put in place the admirable benefits of the Bill, we must ensure that there is proper support for those who wish to study in this area.

Mr. Sackville: My hon. Friend has made an important point which we should certainly address.
While it is widely accepted that patients should have the freedom to choose whom they consult, the osteopathic profession is concerned that there should be adequate safeguards. Under the terms of the Bill a single statutory body—the General Osteopathic Council—will be established to develop, promote and regulate the profession of osteopathy and to set educational standards and standards of professional competence. The general council will also be the shop window of the profession and will play a key role in helping to raise the profile of osteopathy, especially during the formative years of the scheme.
As has been said, the osteopathic profession has been seeking statutory regulation for the past 60 years. Throughout this time no fewer than six private Members' Bills have been introduced to Parliament in an effort to achieve this goal—this compares with the 20 attempts it took to pass the first Medical Act—and that demonstrates a determination and perseverance which have become the hallmarks of the profession.
In 1935, an Osteopaths Bill introduced by the late Viscount Elibank, successfully gained its Second Reading in the House of Lords. It was then referred to a Select Committee where it was felt that
'a sufficiently strong case had not been made for the proposals in the Bill at that time".
As a result the Bill was withdrawn, but its supporters responded swiftly to a suggestion made by the then Minister of Health for the establishment of a voluntary register of osteopaths which should require its members to achieve a level of excellence in training, practice and professional behaviour. In June 1935, a decision was taken to implement this recommendation and in 1936 the General Council and Register of Osteopaths was formed. While that body governs the majority of professional regulated osteopaths, there are also a number of other, smaller bona fide osteopathic registering bodies which regulate and represent the interests of their members. I believe that it is a cherished hope of all those groups that one day their roles might be superseded by the establishment of a single statutory regulatory body which would incorporate the breadth and experience of expertise contained in all branches of the profession. The Bill will, I hope, make that longed-for day a reality.
In 1985, Lord Glenarthur, the Under-Secretary of State in what was then the Department of Health and Social Security, outlined the criteria that the Government expected professions of non-conventional medicine to fulfil before being considered suitable for statutory regulation. The osteopathic profession has been fulfilling those criteria now for a number of years.
However, without doubt, the watershed came in 1988 when the Prince of Wales hosted a luncheon at Kensington palace attended by Health Ministers, presidents of the royal medical colleges and the president of the General Medical Council. At that lunch, the presidents discussed the difference between the therapies that the medical profession considered alternative to orthodox medicine and those that they regarded as complementary. At the end of their discussion, the presidents said that they believed that the way was clear to proceed with proposals to secure the statutory regulation of the osteopathic profession.
It was following a suggestion from his royal highness that the best way forward might be to set up a working party to consider the case for legislation that, in the autumn of 1989, the King's Fund set up its working party on osteopathy. It was chaired by Sir Thomas Bingham, who was then a Lord Justice of Appeal and is now Master of the Rolls.
The King's Fund working party report was launched at a major press conference on 3 December 1991. The conference was attended by the Prince of Wales and a stunning array of dignitaries, royal college presidents and elder statesmen of the medical profession. The Prince of Wales paid tribute on that occasion to the many years


during which the osteopathic profession had been providing high standards of responsible care and conduct which, he said,
'had been of real value to a large number of people".
He congratulated the working party on its report and expressed his hope that, after all its hard work, legislation would follow at an early date. On 17 December Lord Walton introduced the Osteopaths Bill, which the working party had appended to its report, as a private peer's Bill in another place.
Before leaving that subject, I again express the Government's thanks to the working party's chairman, Sir Thomas Bingham, its members and the King's Fund. The working party unquestionably made a significant and central contribution to the osteopaths' pursuit of statutory regulation. The policy underpinning the proposals in the Bill are modelled principally on its recommendations which have provided a fair, sound and practical basis for statutory regulation of established practitioners and provide the public with safeguards for the future.
As the House already knows, the King's Fund has set up a further working party to consider proposals for the statutory regulation of the chiropractic profession. That working party is also chaired by Sir Thomas Bingham and we look forward to receiving its recommendations when it reports shortly. The Government's gratitude to Sir Thomas for his interest in complementary medicine has already been recorded.
I also add my congratulations on the sterling work performed by Simon Fielding in the profession's quest for statutory regulation. Mr. Fielding, himself an osteopath, has worked ceaselessly for that cause virtually all his professional life. He was a key member of the King's Fund working party and also played a vital role in persuading my hon. Friend the Member for Cambridgeshire, North-East to sponsor his current Bill. It is not only fitting but justly deserved that he has recently been appointed chairman of the General Council and Register of Osteopaths.
I have mentioned Lord Walton's Bill in the previous Session. It attracted all-party and Government support and brought to life the recommendations presented in the working party's report. The Bill went on to complete a successful Committee stage before the dissolution of Parliament last March and, in its own right, played a pivotal role in the profession's quest. I am pleased that the noble Lord has agreed to steer the latest Osteopaths Bill on its journey through another place following what we hope will be its successful passage through this House.
I shall now deal with the current Bill, the seventh and latest. My hon. Friend the Member for Cambridgeshire, North-East has already outlined the purpose and content of the Bill and its major provisions. The regulatory system proposed for the osteopathic profession is, of course, modelled closely on that which exists for other major professions, including key health care professions. It also follows the principles for statutory regulation recommended by the King's Fund working party. However, I can confirm that, thanks to the working party, it embodies the most up-to-date thinking on professional self-regulation and will, as my hon. Friend said, provide a model for others to follow.
The Bill explicitly designates professional incompetence as a basis for a disciplinary investigation. I know that other professions, in particular the medical profession, are also investigating ways of introducing that concept for

their own members. The solutions reached may be different for the different professions, but I believe that osteopaths can take credit for the fact that the scheme that they propose seeks to provide the public with the protection that the provision can offer from the outset of the statutory scheme.
Similarly, the Bill contains a provision for the introduction of compulsory refresher training as a condition of continuing registration. Again, I know that that is in line with current thinking in a number of health care professions, offering the reassurance to the public that the practitioners whom they consult are keeping up to date in their fields.
Perhaps one of the most important elements of the Bill is the creation of an offence of using the title "osteopath", or any variation of the term, without being a registered osteopath. I know that that provision is of interest to many related professions. I reiterate the fact that that is not intended to prevent other professionals such as physiotherapists using osteopathic techniques in their practice or telling patients that they are using such techniques.
The offence provides for closure of title, not closure of function. I hope that my remarks will provide some reassurance for those involved. I know that other professions are anxious to secure the closure of their professional title. Our advice to them is to follow the example of the osteopaths and to seek their goal through private Member's legislation.
As careful readers will have noted, the Bill also contains a panoply of appeal rights at various stages of the proposed disciplinary procedures and as part of the registration process. The Government's view is that they are desirable and necessary to fulfil our obligations in human rights terms. The Bill also reflects our European Community obligations in relation to the recognition of professional qualifications.
Added protection for the public is provided through the exemption of registered osteopaths from the Rehabilitation of Offenders Act 1974. That will bring osteopaths into line with other health care professionals and will mean that practitioners will be required to declare all their criminal convictions, including spent convictions, if asked to do so when applying for registration. The General Osteopathic Council will also have the power to ensure that practising osteopaths hold professional indemnity insurance and to take disciplinary proceedings against a practitioner who fails to comply with that requirement.
Nothing in the Bill affects the rights of members of the public to consult osteopaths directly or the osteopaths' professional freedom to treat patients. With all its statutory powers, the General Osteopathic Council will not be able to interfere with the free market in terms of the scale of fees osteopaths may charge. Should the need ever arise, powers of intervention are provided against any anti-competitive practices that the General Osteopathic Council may contemplate.
My hon. Friend the Member for Cambridgeshire, North-East has already drawn attention to the fact that the Bill is expected to have only minor implications for public expenditure. That would arise only in the unlikely event of the Privy Council having to exercise its default powers over the General Osteopathic Council. I confirm that assessment.
The passage of the Bill is not related to the availability or otherwise of osteopathy on the NHS, because, as with


all other services, the purchase of osteopathy is a matter for local decision based on the assessed health needs of the local population, competing priorities and resources. However, we hope that statutory regulation will stimulate the continued growth of the profession and will encourage more people to consider osteopathy as a career.

Mr. Rod Richards: Does my hon. Friend believe that the Bill will make osteopathy more easily available on the NHS—perhaps as easily available as conventional treatment is?

Mr. Sackville: I cannot go further than what I have just said, which is that the Bill will further encourage district health authorities to consider making osteopathy available. It will remain a matter for local choice.

Mr. Jessel: Will general practitioners who are budget holders be able to use their budgets to send their patients to osteopaths if the Bill is passed?

Mr. Sackville: General practitioners have the right to employ osteopaths. I confirm that that is already the case.
The statutory regulations will help to foster closer working relationships between doctors and the profession. I reiterate the point made by my hon. Friend the Member for Cambridgeshire, North-East about the professional and lay members of the first General Osteopathic Council. They will be appointed by the Privy Council after consultation not only with the bodies that currently administer the systems of voluntary registration, but with those that reflect wider views, such as those of the public, of educationists and of the medical profession. The initial members will be appointed on the basis of their individual merit, and for their ability to help to secure the highest standards of clinical practice and to bring out the best ideas from all quarters of the profession.
I underscore the importance of the point made by my hon. Friend the Member for Cambridgeshire, North-East, that the profession should not upset the stability it currently enjoys through the premature anticipation of future change. It is important that individual members of the osteopathic profession continue to support the existing schemes of voluntary registration right up to the time when the new General Osteopathic Council takes on its statutory responsibilities. Failure to do that would result in a loss of public confidence in the profession, it would undermine all that has been achieved so far and it would call into question the professional integrity of those who abandoned a scheme that had brought them and their profession to the brink of achieving their ultimate goal.
I thank hon. Members who have taken part in the debate, in which a number of interesting points have been made. My hon. Friend the Member for Twickenham (Mr. Jessel) mentioned apparent anomalies in terms of VAT. I shall investigate the matter and write to him. My hon. Friend also mentioned the various key areas and targets set in the White Paper 'The Health of the Nation". Further targets, as he probably knows, are under discussion, especially on the question of back pain in which my hon. Friend expresses great interest. He will know that the clinical standards advisory committee is studying the area as one of its special areas of interest. I

hope that we shall have more to say on that. My hon. Friend the Member for Twickenham also mentioned the question of GPs with which I have just dealt.
I welcome what was said by my hon. Friend the Member for Bosworth (Mr. Tredinnick), who has taken an active interest in the House in complementary and alternative medicines. I reiterate his hope that the Bill will take alternative and complementary medicine a little further down the road of acceptance by the medical profession.
We also heard a speech by my hon. Friend the Member for Stafford (Mr. Cash), who is taking a rest from his usual nightly exertions in the House. Some of us were relieved to hear him say that he would leave the European ramifications of the Bill on the table. I am sure that my hon. Friend the Member for Cambridgeshire, North-East is grateful for that. Yet again, I congratulate my hon. Friend on introducing the Bill.
I should declare a personal, family interest. I have just discovered—to my shame, only a few minutes ago—that my late father was the president of the General Council and Register of Osteopaths—[Laughter.] He was a dark horse. I was aware that he was active in another place in promoting the interests of the profession, but the fact that he reached such heights has only just come to my attention.
The osteopathic profession has been running the race in pursuit of statutory legislation for more than 60 years. The Government believe that the case presented by the profession is deserving and justifiable. The King's Fund working party report and the Bill introduced by Lord Walton in the previous Session have taken the profession down the back straight. It is our hope that the Bill will bring the profession not only round the final bend and along the home stretch, but across the finishing line where it can hold aloft the long-sought prize of the Osteopaths Act 1993.

Ms. Dawn Primarolo: My remarks will be briefer than I had intended because many hon. Members have made the points in the debate. It is not worth detaining the House on legislation for which clearly there is so much support.
It is a shame that the Minister drew an analogy between complementary medicines and crossing the finishing line in a horse race. It should have been Government policy to address the important points made today about complementary and alternative medicine. There should have been a positive lead from the Government on how to incorporate the valuable contributions made to the NHS by those medicines.
The hon. Member for Cambridgeshire, North-East (Mr. Moss) has received many accolades this morning. I congratulate him on the Bill, and on his thorough and clear explanation of the range of the Bill, of its intentions and of the clear benefits, especially for osteopaths. Qualification for registration is important. It is important that it should be an offence for anybody to call himself an osteopath without being registered. The whole point of the legislation is to provide protection for the patient.
I hope that, when the Bill is in Committee, the important points made by the hon. Member for Rochdale (Ms. Lynne) will be taken on board. The Bill will then be improved as it makes its speedy way through Committee.
The hon. Member for Edmonton (Dr. Twinn) referred to chiropractors and physiotherapists as well as osteopaths. Physiotherapists have made the same points to Opposition Members, expressing their support for and envy of the provisions envisaged for osteopaths. I sincerely hope that we shall make rapid progress in addressing those matters.
The hon. Member for Twickenham (Mr. Jessel) made an important contribution to the debate, in which he drew attention to the suffering and problems that back pain causes. Back pain is not a fringe consideration: it affects people's lives, work and ability to take part in other activities. We do not pay enough attention to that fact and I hope that, in considering "The Health of the Nation" and improvements in the national health service, we shall bear it in mind.
Before I speak glowingly of osteopaths' contribution, I have been advised to give as my definition of osteopathy that which appears in the King's Fund report, which makes clear the complementary nature of the discipline. Page 10 of the report states:
Osteopathy is a system of diagnosis and treatment which lays its main emphasis on structural and mechanical problems of the body. It is not an alternative to conventional medicine but a complementary discipline which offers patients an additional treatment option for certain conditions which can affect the body's framework. In short, osteopaths are concerned with the biochemics of the body and the maintenance of proper mechanical function.
This is not a debate about complementary medicine, although we urgently need such a debate, as complementary medicine should be available within the NHS.
In expressing its support for the Bill, the British Medical Association has made it clear that it recognises the regulation, education and training of osteopaths in the United Kingdom as most important and believes it to be entirely appropriate that those wishing to practise osteopathy should have to register to do so. It welcomes the establishment of such a register as a guarantee of professional conduct and integrity, which will also afford greater protection to the patient from the potential harm of treatments by unskilled and unauthorised practitioners. The BMA goes on to say that it is currently investigating the control and practice of a wide range of complementary therapies. I suggest that this House, too, should turn its attention to that matter.
A senior clinical tutor at the London College of Osteopathic Medicine tells me that Bernard Shaw performed the opening ceremony at the association's clinic in Vincent square in 1927. I shall not be giving a complete history of osteopathy—although I must say that I am surprised that the Minister omitted his grandfather from the history he gave, and I am glad that he was informed of the fact in time.
On top of his many other talents, Bernard Shaw was a health enthusiasts. Indeed, the reference in the introduc-tion to "The Doctor's Dilemma" to the doctors who were not registered by the General Medical Council but 'who were "rather more successful" than some of their registered colleagues is thought to refer to doctors of osteopathy.
Many people use osteopathy, and the Bill is intended to ensure that greater protection is afforded to them as patients. A study published in this month's British Journal of General Practice draws together some important evidence about the work of osteopaths:

Most of the estimated four million consultations per year in the United Kingdom for complementary medicine are for pain. There are 1,706 registered osteopaths, more than any other group of complementary therapists. Of general practitioners in England, 72 per cent. refer patients to complementary therapy, most commonly for manipulation".
Some practices are already sufficiently convinced of the benefits of osteopathy to offer the service free of charge to their patients within the national health service.
Osteopathy is a little-researched adjunct to conventional primary care. It seems to me that we should be considering the role that it has to play in primary care. It is predominantly used by patients in their working years, especially those with spinal problems, which are often self-limiting. The study reported in the British Journal of General Practice suggests that three visits were usually sufficient to improve the symptoms, and that in respect of women, who attended more frequently than men, the improvement was considerably more marked.
The Bill makes no difference to the availability of osteopathy under the NHS. In considering "The Health of the Nation", we must examine the arguments—and remember the speech made by the hon. Member for Twickenham. Osteopathy has a very good success rate, particulary in relieving spinal pain. In addition to regulation and registration, we should urgently consider including osteopathy in an extended primary health care team and, in the acute sector, as part of the muscle and joint team—rheumatology, orthopaedics, physiotherapy and occupational therapy.

Mr. Tredinnick: Is the hon. Lady aware that a recent survey showed that, in some hospitals, it was found more effective to send patients suffering from back pain to an osteopath rather than giving them the traditional out-patient care? Does she agree that that further illustrates the effectiveness of osteopathy and tells us how important it is that it should be further integrated into the health service?

Ms. Primarolo: I have not seen that survey, but I agree with the hon. Gentleman that we should not neglect the skills, talents and abilities of osteopaths to deal with some types of back pain and spinal injury but should use them to the full. That would have clear benefits not only for patients but for the NHS.
The study to which I have referred shows that spinal joint strain—back problems—shows significantly better symptom improvement at four months with osteopathy than with drug therapy. We must investigate this matter further because if it is true that osteopathy is more effective, there will be bonuses to patients and the NHS alike. For instance, if, in some cases, the complementary use of osteopathy rendered drug therapy unnecessary, there would be a significant saving to the NHS drugs budget. The drug therapies prescribed are often both expensive for the NHS and traumatic for the patient. I do not suggest that the process should be automatic—merely that the possibility needs to be investigated. Moreover, if that were shown to be the case, the dreadful side effects that sometimes result from the use of drug therapies might be prevented.
There is a strong case, on the basis of prevention, health promotion and cure, for examining the role of osteopathy and the other forms of complementary medicines that are available. We agree with the Government that the Bill should have the wholehearted support of the House and that its Committee stage should proceed as quickly as


possible. The Bill demonstrates the way forward for incorporating complementary medicines into the national health service—a debate which the House should have had a long time ago. I hope that after prodding from the hon. Member for Cambridgeshire, North-East we will not shirk the consideration of other complementary medicines. Again, I congratulate the hon. Gentleman on the excellent debate which he initiated this morning.

Mr. Andrew Hunter: I am glad to have the opportunity to add my voice to the supporting choir of hon. Members on both sides of the House, and many organisations and individuals outside the House, in welcoming the Bill. I add my congratulations to those already extended to my hon. Friend the Member for Cambridgeshire, North-East (Mr. Moss). I wish him well, and I wish the Bill a speedy and successful passage through the House.
The hon. Member for Rochdale (Ms. Lynne) reminded us of the lengthy process before the Bill came before us. Undoubtedly, that lengthy time is regretted. Perhaps the hon. Lady and the hon. Member for Bristol, South (Ms. Primarolo) were over-generous in not being more regretful that the Government have not found the opportunity over the years to introduce this measure and that they rely on my hon. Friend the Member for Cambridgeshire, North-East to make amends for that.
Without detracting from the applause which is rightly due to my hon. Friend, I wish to refer to one or two parts of the Bill on which it would be profitable to have a lengthy debate in Committee. I shall be selective; I am aware that other hon. Members have referred to many of the salient features of the Bill. Important business is to follow this debate, and undoubtedly one or two other hon. Members also wish to catch Mr. Deputy Speaker's eye.
I shall refer to the register and the principles of registration. Essentially, the kernel of the Bill is the establishment of a register of lawful practitioners and how such a register will be operated. I do not for one moment quarrel with the principle of the establishment of a register. I think that it is right, and I welcome it.
I share the view of my hon. Friend the Member for Cambridgeshire, North-East that it is right to enshrine two categories of registration. One category is for those practitioners who fully and immediately satisfy the qualification, experience and character requirements. It is right that there should be a category of provisional registration for practitioners who do not fully and immediately satisfy the requirements.
In an intervention to my hon. Friend I suggested that perhaps the Bill would be better if it incorporated provisional registration. I accepted my hon. Friend's reply. In an ideal world, the Bill would incorporate provisional registration, but I accept that perhaps it would be too much to ask the profession to accept that innovation initially, as well as many other innovations.
I seek further reassurance that there will be sufficient protection of the interests of patients during the two-year transitional period. Conditional registration is defined in clause 4(2)(d) which deals with practitioners who are deemed not to have spent a substantial part of their working time over a period of four or more years in the

lawful, safe and competent practice of osteopathy. I doubt whether there is sufficient protection for patients while a register is being compiled in the transitional phase.
After studying the Bill carefully, I am not sure how the disciplinary measures in clauses 19 to 24 will apply during the registration period before the register is complete. If the House permits my hon. Friend to speak again in this debate, perhaps he can clarify the extent to which the regulations in clauses 19 to 24 will be applied before the register is completed.
I believe that clause 4(2)(f) requires greater clarification because it seems to hang at the end of the clause. That provision says:
gives the required undertaking.
In the previous 93 lines in the Bill, there is no reference to any undertaking. What is meant to be undertaken, by whom and in what circumstances? It is hard to follow that provision, and I seek clarification on it.
There is another potential conflict in the Bill. I am aware that my hon. Friend the Member for Twickenham (Mr. Jessel) urged us not to raise Committee points on Second Reading. However, we will not all have the opportunity to participate in the Committee. The potential conflict is between clauses 3 and 4 and the clause which relates to allegations of criminal conviction. Is the concept of the lawful practice of osteopathy in clauses 3 and 4 inclusive or exclusive of unlawful practice overseas? The distinction that unlawful overseas practices are included is made clear later in the Bill. Is that also the case in clauses 3 and 4?
Moving away from the question of the register and the process of registration, I should like to address the issue of post-registration training. It can be argued that the general council should give a greater statutory commitment to post-registration than the Bill provides at present. As hon. Members will know, the working party dealt with that measure in paragraph 47 on pages 28 and 29 of its report. For the sake of brevity, I will not quote the relevant sections of the report. It is available for hon. Members to read if they have not already done so.
Clearly, the working party approached the issue of post-registration training with the view that significant demands should be imposed on the council. In the course of its inquiry, the working party diluted its understanding and its demands until we have the wording in the Bill. Clause 16 would be much better if it read not that:
The General Council may make rules requiring registered osteopaths to undertake further courses of training
but rather "shall make". The working party said that that had changed and that the efforts of the council and the education and training would be directed at raising conditional registration to full registration. That can be accommodated by introducing a time factor—by saying that the post-registration training should start after a certain length of time, following the implementation of the register. I hope that the House will re-examine the "shall" and "may" factor in clause 16.
I shall select one point from those which I intended to make about which I feel strongly. I refer to clause 19(1)(c). The allegations against a registered osteopath which will trigger the disciplinary machinery include the allegation that he has been convicted of a criminal offence. Lord Walton's Bill provided that overseas convictions should be included. This Bill is restricted to criminal convictions in


the United Kingdom. In the helpful notes that my hon. Friend the Member for Cambridgeshire, North-East gave to many of us, he offers justification for that:
Given, however, the differences that exist between the United Kingdom's judicial system and those of other countries it is felt that this could prove too difficult to implement without the Professional Conduct Committee assuming the role of quasi-judicial body, which is not what it is intended to be.
With great respect to my hon. Friend, I quarrel with him on this point. I can clearly envisage criminal offences committed overseas which his Bill would exclude from consideration but which would seriously affect the right of someone to practise osteopathy in Britain. Therefore, I urge that that point be reconsidered. It is in the interests of the patients, and therefore in the long-term interests of the profession, that it is reconsidered. The point which Lord Walton sought to make in his Bill should be restated in this Bill.
I stress that I warmly welcome the Bill. It is long overdue. However, I feel that there are one or two points on which we could have further profitable debate.

Mr. Moss: With leave of the House. I should like to thank hon. Members on both sides of the House for their excellent speeches in the interesting and wide-ranging, as well as long overdue, debate that we have had on this important matter. I thank the Labour and Liberal Front-Bench spokesmen for their speeches and support. I assure the hon. Member for Rochdale (Ms. Lynne) that the matters that she raised will be examined in detail in Committee. I hope that she will be a member of that Committee and bring her expert knowledge to it.
I also thank my hon. Friend the Minister for his speech and for the support of his Department. In all under takings one usually looks for a sign of the outcome. When my hon. Friend revealed his auspicious link with the osteopathic profession through his illustrious forebear, I knew that, rather than the winning post rushing forward, here was a star on the route to Bethlehem which told me that my Bill would have an easy passage through this morning's proceedings and the Committee stage. I thank my hon. Friend for all his contributions to the Bill.
I thank the sponsors of my Bill, many of whom have been present this morning. I thank my hon. Friends the Members for Bournemouth, East (Mr. Atkinson) and for Rutland and Melton (Mr. Duncan) for attending the debate. I thank my hon. Friends the Members for Falmouth and Camborne (Mr. Coe), and for Reading, West (Sir A. Durant), the hon. Member for Birkenhead (Mr. Field), my hon. Friends the Members for Woodspring (Dr. Fox), for Harlow (Mr. Hayes), for Broxbourne (Mrs. Roe), for Bolton, North-East (Mr. Thurnham) and for Bridlington (Mr. Townend) for agreeing to sponsor this important legislation.
My hon. Friend the Member for Edmonton (Dr. Twinn) rightly said that the physiotherapists were worried that they did not have a protected title—something which the Bill gives to the osteopathic profession. But I point my

hon. Friend in the direction of the inadequacy of the Professions Supplementary to Medicine Act 1960, which needs some improvement. My hon. Friend the Member for Twickenham (Mr. Jesse') also referred to that Act.
My hon. Friend the Member for Twickenham also raised the important issue of value added tax on osteopaths' bills. Physiotherapists do not have to charge VAT. I was delighted that my hon. Friend attended the debate this morning. He, too, was a member of the Lords and Commons ski team in Devosse. He fell in a race with the Swiss parliamentarians and ended up in Devosse hospital. I was told that he was receiving excellent physiotherapy treatment under water. One wag in our party was heard to ask how long he had to hold his breath for that treatment.
I thank my hon. Friend the Member for Bournemouth, East for his speech. He referred to chiropractors. I assure him that the King's Fund is to report on the position of chiropractors, in the spring, we hope. There is every sign that the model that we have discussed today will be adopted for that profession.
I thank my hon. Friend the Member for Bosworth (Mr. Tredinnick). I welcomed his speech as the treasurer of the all-party parliamentary group on complementary medicine. He spoke eloquently about the progress and growing acceptance of complementary medicine, and rightly said that the Bill could be an important forerunner of legislation for other groups in the future.
My hon. Friend the Member for Stafford (Mr. Cash) is the chairman of the all-party group. He recognised the sea change in attitude among the public and in the British Medical Association to complementary medicine. I confirm that by reading from a letter from the BMA which I received the other day:
The BMA supports the legislation which seeks to regulate the education and training of osteopaths in the United Kingdom. We believe it is entirely appropriate that those wishing to practise osteopathy should have to register to do so and would welcome such a register as a guarantee of professional conduct and integrity … The BMA's Board of Science and Education is currently investigating the control and practice of a wide range of complementary therapies and will produce a comprehensive report in June 1993.
So my hon. Friend was right to point out that there has been a dramatic change in the attitude of the medical profession.
My hon. Friend the Member for Basingstoke (Mr. Hunter) made a detailed speech. I am mindful of all the issues that he raised. I assure him that if he tables amendments on the points that he made, they will be considered carefully in Committee.
Judging from the speeches of support that have been made today, it appears that the Bill will achieve its Second Reading. That is testimony to the tremendous efforts of many people associated with the osteopathic profession over many years. If congratulations are in order, it is entirely due to them.

Question put and agreed to.

Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).

Medicines Information Bill

Order for Second Reading read.

Mr. Giles Radice: I beg to move, That the Bill be now read a Second time.
This is an important Bill which has all-party support, as the list of sponsors on the back of the Bill shows. Several other Members of Parliament have spoken to me to say that they support the principles of the Bill. Outside Parliament the Bill has the support of the National Consumer Council, the Freedom of Information Campaign and Social Audit. Significantly, it is also supported by a wide range of medical and patients groups, including the British Medical Association, the Association of Community Health Councils, the Patients Association, the Association for Consumer Research and MIND.
I also understand that the Government, committed as they are in their manifesto to greater openness and providing more information for patients, are sympathetic to the principles behind the Bill. The Secretary of State was reported in a newspaper two days ago as saying that she thought that the Bill ought to get a fair wind. The Chancellor of the Duchy of Lancaster told the Treasury and Civil Service Select Committee on Wednesday that he was broadly sympathetic to the aims of the Bill, charged as he is by the Prime Minister with the duty of creating more openness in government.
The purpose of the Bill is to remove the all-embracing secrecy that surrounds all aspects of the licensing of medicines, both human and veterinary. Section 118 of the Medicines Act 1968 prevents the licensing authorities from giving any information about the licensing process. That means that at present the licensing authorities cannot disclose the safety studies that they obtain from manufacturers, including the results of trials of new medicines on patients. They cannot disclose their reasons for granting, suspending or revoking the licence. They cannot disclose the advice received by Ministers from bodies such as the Committee on Safety of Medicines and the Veterinary Products Committee. They cannot disclose the results of inspections showing whether pharmaceutical plants comply with quality control and hygiene standards.
Indeed, when Members of Parliament ask questions of Ministers they come up against a brick wall. For example, when my hon. Friend the Member for Huddersfield (Mr. Sheerman) asked what was being done to deal with the problem of counterfeit medicines, he was told by the Secretary of State that section 118 prevented an answer being given to him. That is the problem which faces all of us when we want to ask questions on behalf of our constituents about drugs and their side effects. That is unacceptable.
Section 118 prevents doctors and medical experts from examining the safety aspects of drugs that they prescribe, which is even more important than the problem facing Members of Parliament when they represent their constituents, and could be to the detriment of patients. While we all accept and admire the benefits that can be derived from modern medicine, powerful drugs, by their very nature, also carry risks. A proper balance can be struck only if we get all the available information about the risks and benefits. We rest our case on the fact that, under the present licensing system, one cannot achieve a proper balance. Doctors are made familiar with the

benefits of drugs by the drug companies and receive a book on drugs being produced and licensed, but, because of the secrecy surrounding the licensing system, it is much harder to establish a full picture of the risks.
May I use a visual aid, Madam Deputy Speaker? There is a drug called Retrovir—I always find it difficult to pronounce the names of modern drugs, but I think that that is correct—and I now show the House the information about it provided for doctors by the industry. As hon. Members know, information about licensing is much more open in the United States of America, and I also show hon. Members the information provided there about the same drug—the summary basis of approval.

Madam Deputy Speaker (Dame Janet Fookes): Order. Could the hon. Member give a brief description of the information, as I think he knows that it is not in order to use a visual aid which cannot be translated into writing?

Mr. Radice: Yes, Madam Deputy Speaker, I understand that. I was trying to point out that if a doctor in Britain receives a description from the industry it is likely to be very brief, whereas a doctor in the United States, with the benefit of a more open licensing system, has access to much more information and can therefore draw a more effective conclusion about the balance between the benefits and risks of medicines.
In some instances, the lack of information could be harmful. I am not trying to be sensational, but I shall quote four examples to the House and it is important for hon. Members to understand the problems that can arise.
First, in the case of the painkiller for arthritis, Opren, we did not know that the drug had been inadequately tested on the elderly patients who were the most likely to use it. Later, 7,000 people contacted the Opren action group to report side effects from the drug and to find out more information. However, they were not able to get the information because of the problems inherent in our licensing system.
The anti-depressant drug Prozac is another example. In 1991, Norway and Sweden refused to licence the drug on the ground that the manufacturer Eli Lilly sells the product only in 20 mg capsules. Some patients need only 5 mg, but the product is not available in that dose, which was why the licence was refused in Norway and Sweden. However, Prozac is licensed in the United Kingdom and is widely used at the recommended dose of 20 mg, rising to a maximum of 80 mg. The secrecy over information means that doctors cannot judge why it is recommended here at levels which are apparently regarded in other countries as excessive for some patients.
Another example is in veterinary medicine and has already been mentioned in the House of Lords. There is growing concern about the toxic effects on humans of using organo-phosphate sheep dips, which have been licensed since the 1970s. Under the present system there is no way to find out whether any trials were conducted on the dips before licensing and, if they were, what they showed.
In 1991, the licence of the tranquilliser Halcion was suddenly withdrawn. Neither patients who were taking the drug, which had been available for about 10 years, nor the doctors prescribing it were allowed to know the reasons behind the withdrawal of the licence.
By reducing the secrecy surrounding licenced medicines and by providing more balanced information, the Bill will


lead to more rational prescribing, which will benefit doctors, pharmacists and publications such as the Drug and Therapeutics Bulletin, from which many doctors get their information. Also, it would have the benefit of making the licensing authorities and the industry more accountable. It would be good for consumers to have full confidence in the medicines that they take and in the regulatory system under which those medicines are licensed. The Bill will also ensure that patients either directly or indirectly, which is the more likely, will have access to information about the potential risks and benefits of the medicines that they take, which is essential.
The Bill, and the model that it suggests, follow the precedent set by the Ministry of Agriculture, Fisheries and Food in the case of pesticides, introduced in 1986, which is to be extended. Like the Bill, the pesticide arrangements involve making a detailed evaluation available, which often amounts to about 90 pages, as well as access to the full data on request and it bars commercial requesters, which is important. We are trying to follow a model which has been set up and is working in this country. In a sense, that strengthens the case for the Bill.
I shall briefly describe the main elements of the Bill. Clause 1 is definitional and clause 2 requires the Minister to maintain an index, which can be held in any form—electronic or otherwise. The index would identify three types of information: first, it would identify drugs that are subject to certificates and licences under the 1968 Act; secondly, it would identify types of information to which the public would have access; and thirdly, it would identify convictions under the 1968 Act.
Clause 3 is important because it is central to the Bill. It establishes a right of access to information on licences in force; the summary and evaluation of drugs—notably information about the safety and effectiveness of drugs; information considered by the licensing authority before granting a licence or before suspending, varying or revoking a licence; advice given by bodies such as the Committee on Safety of Medicines; and inspection reports on the manufacture and premises of firms that produce drugs.
May I make it clear that all information available under the Bill will be subject to two safeguards. I realise that a number of hon. Members and the drug companies are worried about that. The two safeguards cover, first, trade secrets and, secondly, the fact that the information will become available only once the product has been licensed and launched.
Clause 4 establishes, subject to ministerial approval, a wider right of access to information and extracts of information about the safety, quality and effectiveness of medicines, which may be necessary if the summary and evaluation are not detailed enough.
Safeguards are considered important by the industry and the country as a whole. Clause 6(2) excludes information about the manufacturing process that would damage commercial interests. It also excludes information about a product being developed, which has not yet been licensed. Clause 8 continues to make it a criminal offence to release information about the manufacturing process or a product being developed.
Clause 5 allows Ministers to exclude from wider access under clause 4 any person acting on behalf of a commercial interest. The Minister must be satisfied that the person has no commercial interest and may require legally enforceable undertakings to that effect.

Mr. James Couchman: May I first declare an interest? I advise a pharmaceutical company, so there should be no misunderstandings on that. I am particularly worried about what the hon. Gentleman has just said, because the safeguards in the Bill seem to be weak in the extreme. Although undertakings may be given, it would not be the first time if such undertakings were not adhered to. What real safeguards is the hon. Gentleman putting into the Bill to prevent someone who has signed an undertaking from passing that information on to copyists or, in some ways more frightening, to an animal liberation outfit that could gain information about animal testing? That is of considerable concern to people working in the industry.

Mr. Radice: I understand the hon. Gentleman's concerns, but the Bill is modelled on the pesticides arrangements and they have not led to the problems that he suggests might arise. After all, he must bear in mind the fact that some of the companies that produce drugs also produce pesticides. I am well aware of the problem. If the Bill is given a Second Reading, I hope that he will give his advice and help in Committee so that we can tighen up any weaknesses in the Bill. I hope that he will consider what I have said in a sympathetic light.

Mr. Andrew Hunter: I do not have an interest to declare, but I have major pharmaceutical companies in my constituency. A great deal of investment in the United Kingdom industry comes from foreign companies. It is feared that a regime such as that outlined by the hon. Gentleman will deter investment. It is not just a question of its implications in practice; it would deter further investment and thus undermine the prosperity of the United Kingdom's pharmaceutical industry.

Mr. Radice: My understanding is that the very open system of regulation that operates in the United States has not deterred investment by foreign companies. I am not convinced that the problem is as serious as the hon. Gentleman suggests, but clearly we should examine that aspect. I do not believe that companies will have anything to fear if their drugs are properly tested. The trend that the hon. Gentleman suggested has not been seen under the pesticides model—neither does it occur in the United States.
If foreign companies want to market their products in the United Kingdom, they will have to license them here, which means that we shall have access to their data. That will ultimately be useful to United Kingdom companies. Again, that matter can be reviewed in Committee. It does concern me, and it is important that we get it right.
Clause 3(2) and clause 4 make it clear that information will be available only after the product has been licensed and launched. The Bill also provides protection for other groups. The identity of patients, doctors, and researchers undertaking animal experimentation will not be disclosed.
The industry has suggested that the Bill could become a counterfeiters' charter. We have tried to bar commercial interests, on the pesticides model. Only extracts will be published, not full data, and information about the manufacturing process and about products under development and not yet licensed will not be divulged. All those safeguards should be taken into consideration.
The hon. Gentleman raised the question of cost. That matter is for discussion and for the Government to decide. As the Bill bars commercial interests, the cost is likely to


be far smaller than in the United States where, because commercial interests are not barred, the system is more expensive. I suspect that the system proposed by the Bill would not he very costly. I pray in aid again the pesticide arrangements, which are not costly. Costs can be exaggerated as an argument against giving the Bill a Second Reading.
In any case, as I have made clear, I fully expect the Bill to be amended in Committee. I have had helpful discussions with the Department of Health at six meetings over a number of months, but they have not yet been concluded. The Government have not produced any firm, detailed proposals of their own, so the Bill is inevitably in draft form. I do not pretend otherwise. I would of course have responded before Second Reading if the Government had made their intentions clear and said what they wanted. I could not, so perhaps some of the Bill's imperfections—if it has any—are not entirely of my own making or that of the Bill's sponsors or outside groups that support it.
I hope that those who have problems with the Bill will sit on the Committee and try to improve it, so that we can introduce more openness in regard to important licensing decisions, while protecting the legitimate commercial interests of drug companies, which I am anxious to do.
The Bill will give doctors more information about the medicines that they prescribe, and will let patients know more about the possible side effects of those medicines. The licensing agencies will be able to explain the reasons for their decisions and pharmaceutical manufacturers will have the discipline of knowing that the safety of their medicines will be subject to wider scrutiny. That will be good for doctors, patients, the licensing authorities and, I believe, the pharmaceutical industry. I hope that the House will give my Bill a Second Reading.

Mr. David Atkinson: I welcome the Bill, in the light of the experiences of a number of my constituents and many other people who have written to me about the often permanent damage to children's skin which has resulted from long-term application of steroid creams to combat eczema. A recent Sunday Express campaign exposed the extent of those sad cases; I believe that the Bill will do much to reduce them by providing GPs, patients and their families with more information about the products concerned. It will also concentrate the minds of GPs who prescribe ointments without regard to either their efficacy or their effects on patients.
The ointments most frequently mentioned are Betnovate N, Dermovate, Eumovate and Propaderm A. They should of course be used sparingly; certainly they should not be persevered with if they are not working. Unfortunately, the Sunday Express and I have been informed of all too many cases of such prescriptions being repeated by GPs—sometimes for years—without any evidence of their efficacy. Permanent scarring has resulted; skins has become almost transparent in places, with blood vessels and veins becoming clearly visible. We can only imagine the psychological distress caused, to, in particular, young people of both sexes. Indeed, suicides have been known. Other side effects are obesity, owing to the cortisone ingredients absorbed into the bloodstream, and a loss of natural immunisation against infection.
Some GPs are clearly unaware of those dangers, and some do not appear to be particularly interested when patients discover alternative therapies—for instance, homoeopathic or aromatherapeutic herbal medicines—that succeed, often within weeks, where pharmaceutical products have failed, as well as being much cheaper. Producers will claim that they provide the widest possible advice on the application and administration of their products—which, in any case, must satisfy the Committee on Safety of Medicines before a licence can be issued.
I hope that my hon. Friend the Minister will investigate the worst of the cases of which I have been informed. I shall send him the details.
I am sure that the Bill will go a long way towards ensuring that such sad and unnecessary cases of suffering are never repeated, and I hope that it will be given a clear passage. I congratulate the hon. Member for Durham, North (Mr. Radice) on introducing it.

Ms. Liz Lynne: I welcome the Bill, which is a positive step towards ensuring that patients and doctors have more information. We should ensure that we get rid of the secrecy that surrounds so many areas of our life.
I know several patients who have been to doctors and been prescribed treatment without being told of the side effects. They have seen their doctors numerous times and said, "I am suffering from this," but quite often their doctors do not know what the side effects are. That is why I support the Bill, which will bring our legislation into line with the extremely good legislation of the United States, under which people are able to discover the side effects of treatment.
I know that some European countries do not have such strong legislation. If the Bill is passed, we should put pressure on our European colleagues to ensure that legislation is introduced across Europe. That would go some way to allay the fears of some Conservative Members that competition would be difficult and that people would not want to invest in this country. It would help if we could make legislation apply across Europe.
I can understand the fears of the pharmaceutical industry about, for example, trade secrets, but that is covered by the Bill. Perhaps, as the hon. Member for Durham, North (Mr. Radice) said, the Bill's provisions need tightening, but that can be addressed in Committee. The most important thing to remember is that people's health is paramount, as the Government suggest in their White Paper "The Health of the Nation". People should take more responsibility for their health care needs. If the Government believe in the proposals set out in the White Paper, they should support the Bill.
Some drugs have been withdrawn. The tranquilliser Halcion was withdrawn in 1991, but none of us has been told why. We are unaware of the side effects of similar drugs that are on the market. More drugs are being produced without our knowing their side effects, but we need to know in order to protect our health and that of our constituents. It is unacceptable to use the trade secret argument when the health of people should be paramount.
I should like to give my wholehearted support to the Bill. Obviously amendments will be tabled in Committee, but I should like to give the Bill the support of my party.

Mr. James Couchman: I had not intended to speak, but I repeat that I advise a pharmaceutical company in Kent. I make no apology for offering the hon. Member for Durham, North (Mr. Radice) some of the fears of the industry. I know that he has been approached by companies and by the industry's association, the Association of the British Pharmaceutical Industry, in various letters and meetings.

Mr. Radice: I have had meetings with the industry, but more meetings, particularly at the Committee stage, would be extremely useful.

Mr. Couchman: I welcome the hon. Gentleman's assurance on that point. It is important that, if the Bill gets its Second Reading and goes into Committee, a better Bill emerges.
The pharmaceutical industry is one of our success industries. Our companies lead the world. Four out of 10 of the world's leading products come from the British industry, which is a strong industry that provides the country with a substantial trade surplus of £1.2 billion. Not too many of our industries are in that happy state. It is important that we maintain the investment confidence of the industry. I am worried about that confidence, given that, unhappily, the Bill is being presented at the same time as the Department is threatening an extension of the limited list provisions, which is also seen as a threat to investment by the pharmaceutical industry.
One reason why this country has attracted industry from overseas is the strength of our research and science, and our development of the pharmaceutical industry. It is a shining example to other manufacturing and research-based industries. I am worried that, as a result of the unhappy concomitants of the perceived threats to the industry, investment decisions prejudicial to the United Kingdom will be taken.
I hope that I may be able to take up the invitation extended by the hon. Member for Durham, North to join the Committee, but I am also tied up with a number of other Friday Bills, which may have to take precedence over his for my services.
I see the Bill as a threat to the intellectual property rights of the research-based pharmaceutical industry. In my intervention in his speech, I told the hon. Gentleman that the safeguards in the Bill to prevent dissemination of information are weak. They are seen as highly threatening because of the danger that generic copyists, or even people who might make fraudulent applications for product licences, as has happened recently in the United States, might get their hands on the information. Research workers in the industry are also worried by the prospect that their safety could be threatened by the Animal Liberation Front, which has extreme views on people doing research in the industry.
The hon. Gentleman placed great store on comparisons with the pesticides industry, but the two are not the same. The pesticides industry does not have the same amount of generic competition as the pharmaceutical industry, and the scale of the industries is also different. The pesticides industry has an annual turnover of £700 million, whereas that for the pharmaceutical industry is almost 10 times bigger. In addition, although innovative pharmaceutical

manufacturers receive limited patent protection, no such protection exists for vaccines and products of bio-technology.
I am also concerned that the European agency proposed for pharmaceutical licensing will not come here if we pass the Bill. That would be regrettable, because, in respect of the pharmaceutical industry, we lead in Europe. It would be a great benefit if the European Medicines Evaluation Agency were to be located in this country when it is formed.
The hon. Member for Durham, North pre-empted my second intervention in respect of the cost of the legislation. At the moment, the pharmaceutical industry pays money to the Medicines Control Agency for product licences, because it perceives the licence as a service provided by the MCA to the industry. The industry would view the Bill as a disservice rather than a service to it. It would certainly be highly unlikely to be a willing contributor to the cost of the dissemination of the information.
Therefore, the hon. Member for Durham, North must recognise that the people who seek information under the Bill will have to pay for it themselves—which could amount to more than just the cost of providing a large quantity of photocopied material—or the cost will fall on the taxpayer. I am sure that the Parliamentary Under-Secretary of State for Health, my hon. Friend the Member for Bolton, West (Mr. Sackville) will have something to say about the likelihood of the Treasury wishing to pay for information to be disseminated at a time when the Treasury is seeking to curb the drugs bill.
I have probably said enough now to show the industry's concerns. The industry is taking steps to disseminate more information about medicines. It would much prefer to see a basis whereby the Medicines Control Agency acceded to the EC initiative to provide summary bases of approval in respect of all newly licensed medicines. That certainly seems to be a way forward to provide more information to doctors and to patients.
While I wish the hon. Gentleman's Bill a fair wind, I hope that, in Committee or on Report, if necessary, he will be prepared to accept amendments that truly safeguard the rights and justified commercial interests of an important industry—the pharmaceutical industry.

Mrs. Judith Chaplin: Like motherhood and apple pie, we are all in favour of as much information as possible being given to as many people as possible in all aspects of life. Having worked in government, I know that many papers that cross one's desk marked "confidential" probably need not have been confidential. I welcome the fact that the Government are committed to much more open government in all its aspects and to extending the information that is provided to people. However, there must be a balance. We should not go to the opposite extreme and remove confidentiality, when there are valid reasons for it. As other hon. Members have said, there is a risk that the Bill could damage commercial interests.
Most medicines take many years to develop. I believe that the average time is 12 years. Their development involves substantial costs. Up to £150 million can be involved in the development of a medicine. Even when medicines are developed and licensed, many are not commercial successes. Therefore, there is a high cost to the


pharmaceutical industry in respect of developing medicines which we all want to deal with illnesses that afflict us today.
Patents can cover 20 years, but they are registered at the beginning of the process. Therefore, medicines are not protected for a particularly long period. The Bill could provide competitors with an unfair advantage. Indeed, it could damage the pharmaceutical industry in this country and, as my hon. Friend the Member for Gillingham (Mr. Couchman) said, the pharmaceutical industry is a very important industry in this country.
I have examined the Bill carefully, and I do not see how clause 5 can be enforced or effective. I am always worried about legislation which cannot be enforced correctly.
For example, people involved in industrial espionage do not pull a hat down over their faces and put on dark glasses. One cannot tell who is a spy and who is an ordinary person making innocent inquiries about the ingredients of a medicine. Therefore, it is extremely unlikely that the clauses which seek to prevent commercial spying will be effective. If they are not effective, there is the risk of damage to the industry in this country, and the risk that it will go elsewhere.
It has been suggested that it would be acceptable if similar legislation were in force across Europe, but that would still not be sufficient to prevent companies from manufacturing in other countries and therefore reducing the amount of work they carry out here. It is extremely easy for most of the companies involved, many of which are in any case international companies, to re-base where they do the bulk of their work, which could do great damage to our balance of trade if several moved overseas. As my hon. Friend the Member for Gillingham (Mr. Couchman) said, there is a great trade surplus from the pharmaceutical industry, and we need to keep it here.
We also need to protect the jobs provided by the industry—about 80,000 direct and about 200,000 indirect jobs. Even more important, we must keep the research and development skills of people in the industry. By that I mean research and development not only in the industry itself but in universities and elsewhere. We should not wish skilled people to go overseas, which would be a possibility if there were a threat to the industry. The Labour party shares those aims, so I am sure that the hon. Member for Durham, North (Mr. Radice) has borne them in mind when considering the Bill.
The Bill leads us to ask whether the current secrecy is too great. I entirely agree with the hon. Member for Durham, North that it is, but that does not mean that we should go to the other extreme and give too much information. I hope that I have made it clear that I would not wish us to go to the extreme proposed in the Bill, but there is no reason why the data sheets, or compendiums, about medicines available to people should not be re-examined to ascertain whether more information can be given without running the risk of damage to commercial interests.

Mr. Radice: I hope that, in making her measured speech, the hon. Lady has taken on board the fact that we are discussing safety studies, not general information about the manufactured product or the development process. I should have thought that safety studies should be available in the public interest.

Mrs. Chaplin: I agree that more detail should be available of studies and tests that have been carried out and what effects have been recorded. However, the difficulties relating to Opren or some medicines for eczema appear to have occurred because of inadequate testing rather than the lack of information available on them. It is absolutely right that there should be wider discussion about such tests, but that does not mean giving information that could damage the competitive advantages of those who have produced a drug.
I agree that section 118 of the Medicines Act 1968 must be reconsidered, but not to the extent of an excessive removal of restrictions, which could lead to a greater threat of our industry going overseas. I also agree that the Medicines Control Agency should give details on, for example, why it has withdrawn a drug, further details of standard testing and what has been decided about different aspects of a drug. All these issues could be reconsidered so that more information could be given, enabling people to decide for themselves whether a drug's side effects are too great.
I have some doubt about whether that is the best approach. All of us know that, when looking at an encyclopedia of the 100 most common diseases, many people decide that they have at least 90 per cent. of them, and that their death is imminent. I am concerned about people being made nervous about a medicine which they could take quite safely and which would benefit them.
I believe that an area of information can be expanded without going to the extremes that appear in the Bill. The Bill requires substantial alteration before I can support it.

Mr. Piers Merchant: I congratulate the hon. Member for Durham, North (Mr. Radice) on introducing the Bill, which is principally designed to push back the frontiers of secrecy. Incidentally, the Bill seeks to reverse a measure passed by a Labour Administration in 1968. I am glad that the Bill commands obvious support in the House and beyond. I support the basic principles behind the Bill and although I have some reservations of detail, none would stop my general support for the Bill.
There are two particular reasons why I am keen on the Bill. I am strongly committed to freedom of information. I believe that all information should be freely available unless there are overwhelming reasons against that availability. That point should be as relevant to all appointed statutory bodies, such as those governing the safety of medicines, as it is to elected bodies.
The spirit that applies is the same as that eloquently set out by Lady Thatcher in her maiden speech in this House. She said:
The public has the right, in the first instance, to know what its elected representatives are doing."—[Official Report, 5 February 1960; Vol. 616, c. 1350.]
She was speaking on what became the Public Bodies (Admissions to Meetings) Act 1960. The public has an equal right to know what those appointed to guard its safety on medicine and drugs are doing and why they are doing it.
Freedom of information was further enhanced as a general subject in 1985 with the Local Government (Access to Information) Bill, which was introduced by my hon. Friend the Member for Hornchurch (Mr. Squire). I was lucky enough to be able to support it in a speech in the House. The same principles that drove me to do that


encourage me to support the Bill today. In both cases, there are exceptions to the general principle of freedom of information. The Bill recognises that and it specifically grants exclusions to genuine trade and commercial secrets. The Local Government (Access to Information) Act grants exclusions for personnel matters. It is right that the Bill should allow exclusions.
I attach great importance to the need to protect pharmaceutical companies in that way. I do not believe that the hon. Member for Durham, North seeks to diminish that protection. However, I have some doubt about the sufficiency of the Bill in that respect. The hon. Member has been gracious enough to say that he is willing to be flexible in that area.
We must be careful not to discourage the huge investment that pharmaceutical companies put into the commercially risky and uncertain area of research. It is difficult for companies to assess in advance exactly how great the resources need to be to bring a research project to fruition. In many cases, research projects do not come to fruition.
We must ensure that pharmaceutical companies, which are strongly based in this country, do not lose confidence as a result of the Bill to the extent that they seriously consider moving their operations offshore where they could use a safety regime that might not be as onerous in its requirement to publicise the information gained in research and in bringing the drug to the market.
I am a little worried, too, about the implications that may flow from the single European market. Directives governing such matters are, of course, in train, but we all know that, although on paper such directives may place the various countries of Europe on an equal footing, in practice, there are some countries whose regimes may be less onerous and therefore more acceptable to companies that are worried about such matters. I am not as convinced as some of my hon. Friends that that is a real danger. I agree that the possibility exists, but feel that the difference between the safety regime established under the Bill and the safety regimes of other countries would have to be very great to persuade companies to move offshore. Given that many countries are now moving to tighten their safety regimes, I doubt whether the differences would be sufficiently great for that situation to arise. It is, however, something which needs to be watched.
I am especially doubtful about the clause to which my hon. Friend the Member for Newbury (Mrs. Chaplin) referred, which permits access to certain information on a selective basis; access must be given only to people who the Minister is satisfied are not connected with the drugs industry. In the age of photocopiers and faxes, not to mention telephoto lenses and listening devices, it is hard to imagine that those involved in a highly competitive industry will for long be denied information that is available to other people—no matter how that informa-tion might be transmitted. We need to examine more closely the practice of that clause, rather than confining ourselves to the theory behind it.
Having made those cautionary points, I come to my second reason for supporting the Bill. More and more medicines are available and more and more are prescribed. The public are more aware and better educated than ever before about medical matters. That is a good thing and, as has been said, the process is being encouraged by the Government: the public are being urged to look in detail to their own medical care. They are rightly entitled to

information about the drugs that may be prescribed to them. There have been some tragic safety lapses. It is only right, therefore, that there should be an effective and credible system to protect the public which is not just thorough and fair but is clearly seen to be thorough and fair.
At present, the system is not seen to be thorough and fair because of the restrictions imposed under the Medicines Act 1968, some of which are clearly absurd. To my mind, the restriction on reporting by factory inspectors on quality control and hygiene in pharmaceutical manufacturing plants is quite unacceptable. Information concerning manufacturing units in Britain that is not available publicly in this country because of the 1968 Act is available in the United States of America, so any argument against making such information available falls at the first hurdle.
Hon. Members who have asked parliamentary questions on entirely innocuous matters have been given no information because of the requirements of the Act. For example, on 5 February 1987, the hon. Member for Kingston upon Hull, North (Mr. McNamara) asked about the location—only about the location—of overseas manufacturing sites of Generics UK Limited that had been inspected and was given the answer that the information was not available because of the requirements of the 1968 Act. The Bill corrects such problems and, at the same time, makes vital information available to doctors, patients and the public. With such information, they can play an active role in monitoring the system not only of drug safety but the drugs themselves. They can feed back vital information which can play an important part in establishing whether the drugs in use are safe. That would extend not simply the feeding of information but the safety of medicines generally.

Mr. Richard Alexander: On the face of it, this Bill looks like a good idea. However, on close investigation, it could prove more harmful than all the benefits it could give. It could have devastating effects on the pharmaceutical industry which, without doubt, is one of the United Kingdom's greatest success stories.
The hon. Member for Durham, North (Mr. Radice) proposed the Bill in a most reasonable way. He said that he expected the Committee to be able to provide the safeguards. However, people who are anxious about safeguards expect them to be better spelt out and agreed with the industry involved, rather than the matter being left to the speculative results of the Standing Committee.
As with many other Bills with good intentions, this Bill, which gives patients and doctors more information on which the safety of medicines will be judged, is flawed because it increases access to commercially confidential information in a way that no other country allows. It is a recipe for ensuring that pharmaceutical companies in the United Kingdom will seriously consider leaving this country. I know that that is not the wish of the Bill's sponsors, but they must recognise the side effects which it could produce.
The United Kingdom has always recognised intellectual property rights. The Bill undermines those rights; they could be swept away with one blow. Industries that have built up commercial know-how and expertise, and which


always believed that Britain would protect them, now find that properly patented rights are worthless. That is the danger with the Bill.
The sponsor of the Bill seems to recognise that both the Association of the British Pharmaceutical Industry, to which reference has been made, and the National Office of Animal Health Ltd. think that the safeguards in the Bill are meaningless. Those organisations live with the facts of that daily. The piracy of patented goods and products is an international problem, as any owner of a genuine Rolex watch will soon tell us. The Bill will immediately make confidential secrets and know-how international property. If it is to see the light of day, it must contain more meaningful safeguards.
Pharmaceutical companies in the United Kingdom cannot introduce expensive research, knowing that the patent protection which existed previously will be worthless. The potential loss of employment in companies, universities and medical and veterinary schools will be considerable. People outside Britain sometimes think that we can never have a successful industry without a politician wanting to interfere with it, for very good reasons, and ruin it by a side wind.
My hon. Friend the Member for Gillingham (Mr. Couchman) said that there is hope that the European Medicines Valuation Agency will be sited in the United Kingdom. There is expertise here on which it could draw. We could say goodbye to any such prospect if the Bill were passed.
Of course patients should receive more information about the benefits and risks of medicines prescribed to them. Patient information is growing in Britain and we all welcome that. Of course regulatory authorities must have access to the facts on which newly patented medicines are approved. But a Bill giving access to all safety, quality and efficacy data in support of a product licence application would be open to abuse and commercial exploitation by competitors.

Mr. Radice: It is not all the information. It is a summary of the information. It is the information provided by the licensing authority. While I have every sympathy with the anxieties of the industry, it does not help to exaggerate in the way that the hon. Gentleman has just done.

Mr. Alexander: I am not a spokesman for the industry. I have studied the Bill. I have no commercial interest to declare. The hon. Gentleman has made his points and I am making mine.
It is all very well to say that the information could not be passed on to a person with a commercial interest in that product. But how can anyone prevent the information from being passed on? That is the nub of the objections to the Bill. I understand that, apart from Denmark, no country has comparable legislation or proposes to introduce it.
As a result of the Bill, British and foreign-owned companies would no longer make product licence applications to the United Kingdom Medicines Control Agency. That is a genuine fear. They would be sensible to go elsewhere. Another of Britain's major industries would fade away as a result of well-meaning politicians interfering in matters about which industry knows best.
As our pharmaceutical industry obtains product licences in Britain, British patients are often the first to benefit from new medicines. That advantage would also be lost if the Bill proceeded. We could forget the prospect of foreign companies considering pharmaceutical research and production in Britain if they had not already obtained licences.
The industry produces a trade surplus of £ 1.2 billion for Britain. The Bill would put much of that at risk. The danger is as strong as that. The National Office of Animal Health Ltd. has described the Bill as
well meaning but potentially damaging and dangerous".
For that reason, I cannot give it my support.

Lady Olga Maitland: I have listened to the debate with tremendous interest and sympathy. I congratulate the hon. Member for Durham, North (Mr. Radice) on having the spirit and enterprise to concentrate on removing secrecy where it is not needed. We have covered a tremendous amount of ground in that regard. The secrecy element of section 118 of the Medicines Act 1968 is clearly outdated.
In the anxiety to make good a weakness, there is a tremendous danger that we could throw out the baby with the bath water. As other hon. Members have said, we must be careful about hitting the pharmaceutical industry too hard and therefore killing the golden goose—if I may use two metaphors in a row. This is almost a case of overkill.
The United Kingdom pharmaceutical industry is the best in the world. It is the fourth largest exporter after Switzerland, Germany and the United States of America. It employs, directly and indirectly, more than 300,000 people. That is many jobs. The industry made about £550 million worth of capital investment in 1990. Four of the world's top-selling medicines were developed in Britain. The industry's exports are valued at nearly £3 billion, making it the second largest contributor to Britain's net balance of trade after power generating machinery.
In short, we owe the industry a debt for its research, investment and innovative science, which raises a valid question about the balance between the interests of customers, the consumers, patients, doctors and the industry. I acknowledge that the hon. Member for Durham, North and his sponsors recognise that that is a sensitive area which must be examined. The problems have been highlighted by my hon. Friends the Members for Gillingham (Mr. Couchman), for Newbury (Mrs. Chaplin) and for Beckenham (Mr. Merchant) and I make no apologies for repeating some of their concerns. We should consider the industry's fears that commercial interests could be adversely affected if it has to make all the data available, as set out in clause 4. It sounds reasonable enough to say that information on safety, quality and efficacy should be given, but that could cover a wealth of information which could be poached by an industrial rival, such as detailed results from clinical trials.
I should like to know what the hon. Member for Durham, North means by a "summary"—I think that that would allow abuses of the system. The Bill does not go far enough to safeguard commercial interests. Under the 1968 Act, volumes of information could be made publicly available because companies have freely submitted information in the knowledge that it would not be revealed to a competitor or a third party. As the data are so


detailed, it could be abused by potential counterfeitors. Companies might use the information as a basis for a fraudulent licence application, as has happened several times in the United States in recent months, where such material is available under freedom of information legislation. That might also happen here as the Bill could aid potential generic copyists here or abroad. An example of such a case in America was when Bolar and Vitarine were charged in 1990 with undercutting Smith, Kline and Beecham in a generic drug scandal. PharmaKinetics was charged with fraud in a similar case in 1991. Those are serious occupational hazards.
The safeguards in the Bill against data being used and exploited are flimsy and easily open to abuse. The Bill seeks to give access to all data to everyone except
a person with a commercial interest in the industry".
Who will decide who is a suitable person? How does one prove that they are not? How can one assess someone's intentions? The Bill is fraught with dangers, which could result in legislation and plenty of work for the lawyers, but I am not sure that it would have much benefit for other people.
The Bill states that it will keep from the public only genuine trade secrets, such as techniques for manufacturing drugs, but people will have access to information on the rest of the trials submitted if it can be shown that they wish to further "public discussion" of the safety and efficacy of the drugs concerned. It would therefore be wise for the sponsors to stiffen the safeguards against the misuse and exploitation of such information.
We must bear in mind companies' reactions if they are faced with the almost crippling requirements in the Bill. They would take off elsewhere and that would be a great shame, as the industry has such high standards in this country. That would mean that our launch pad for the pharmaceutical industry would never be the same again.
The hon. Member for Durham, North mentioned parallel legislation in the pesticides industry. However, pesticides manufacturers are not subject to the same intensity of generic competition as the pharmaceutical industry, so it is not a real parallel.
In spirit, I welcome the proposed Bill, despite my remarks. Section 118 of the Medicines Act 1968 is a suitable case for treatment. There are benefits, but, as with all drugs, they must be taken with care.

The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville): I congratulate the hon. Member for Durham, North (Mr. Radice) on introducing the Bill. He was characteristically well informed in his assessment of the Government's attitude. We do not object to the principle of the Bill.
First, may I give a little background to drug regulation in this country? The drug regulation system in the United Kingdom is one of the most stringent in the world and provides the nation with the reassurance that the medicines they take are safe, efficacious and of good quality. That is something we should be grateful for. But this has not always been so. The pharmaceutical market remained comparatively free from controls until the early 1960s, when the promotional claims for a specific drug were seen to be tragically inaccurate. The Medicines Act 1968 provided a framework for the regulation of the safety, quality and efficacy of all medicinal products and was designed to close regulatory loopholes that allowed a

drug such as thalidomide to be given to women in early pregnancy, with consequences of which we are all sadly too well aware. The Act achieves its aim by a number of integrated controls but chiefly by means of a licensing system that grants, renews, refuses or revokes permission for the supply of medicinal products for human or animal consumption. Those controls include the manufacture, distribution, marketing and advertising of medicinal products.
However, medicines regulation is an area where there are extensive restrictions on the disclosure of information. Under section 118 of the Medicines Act 1968, the disclosure of information supplied to the licensing authority is generally forbidden. The only exception to that is where there is a "duty" to do so—either as part of the function of licensing or where public health or safety are at risk. That is because there is an underpinning common law obligation to respect the confidentiality of the information presented by companies seeking marketing authorisations. There is also a duty to maintain the anonymity of individuals whose identities may be known because they have taken part in clinical trials or post-marketing surveillance studies. The amendment to section 118 is at the heart of the Bill.
The hon. Member for Durham, North has already eloquently outlined the benefits of the Bill as he sees them, and I need not take up the House's time in repeating them. None the less, it is worth making it clear that the Government are committed to promoting greater openness in government. To make more information available to the public in the field of medicines and medicines control in general would no doubt contribute a positive step in that direction. I recognise that the Medicines Act has been regarded and quoted as one of the long-standing statutes that provide for little or no information to be provided publicly, and I am sure that it is right to view very positively the prospects for opening up to public scrutiny at least some of the information held by the United Kingdom Medicines Licensing Authority. I am sure that steps in that direction are, in principle, something which the Government would wish to consider very positively.
The Bill would require the licensing authories dealing with both human and veterinary medicines to publish detailed information about their decisions and make available on request full information about the safety, quality and efficacy of medicinal products. Again, I am sure that access to increased information would represent a very important contribution to public information in an area that impinges on the day-to-day lives of virtually every member of the community.
Information about the medicines that people are taking, their side effects, and warnings that need to be given are important pieces of information with which individuals can balance the risks against the benefits of medicines. The consumer safety information provided with applications for veterinary medicines for use in food-producing animals, the residues of which might enter the food chain, is also very important. In addition, and importantly, doctors and vets could obtain more information about the medicines that they prescribe to enable them, too, to learn more about the medicines, benefits and their potential side effects, so that they would be in a position to give fuller advice to their patients and users of animal medicines.
Access by the public to information on adverse drug reactions is also a potentially important development. Great care would need to be taken in ensuring that the data that are available to individual members of the public are fully validated, and presented in a balanced way which avoids the risk of unnecessary public anxieties—or, worse, patients being panicked into no longer taking medicines that are in fact remarkably safe and efficacious for them. Where animal medicines are involved, withholding them could lead to animal welfare risks. In addition to information on medicines, their benefits and their risks, the public could also benefit greatly from more informed discussion in the scientific and medical community and also by patient and consumer bodies of the advantages and risks of particular medicines. Again, that would contribute to ensuring that medicines are prescribed and used appropriately.
However, the issues are more complex than might at first be apparent. Against the advantages that greater freedom of information would bring, some of which I have just outlined, we also need to consider some potential disadvantages and dangers. Some of the proposals in the Bill as drafted may go further in providing information than is necessary to permit informed analysis of the medicines available. Clause 4, for example, would require all data files to be opened up.
We need to consider very carefully the additional burden that the proposals would put on the pharmaceutical industry and the very real risks that the Bill, as drafted, would run in endangering the information—some of which is commercially highly sensitive—that companies have lodged with the licensing authority. There is also the danger that the United Kingdom may get too far out of line and prejudice its position as the European Community develops systems for the future licensing and control of medicines.
As everyone knows, the pharmaceutical industry is one of the jewels in our trading crown. It is a buoyant industry. United Kingdom drug manufacturers have produced a large balance of trade surplus over the decades. The United Kingdom pharmaceutical industry is the third largest exporter of medicines in the world. In 1990, the value of exports topped £2.2 billion. However, these are difficult times for all manufacturers and I am concerned that at a time when we are determined to reduce the burden government places upon industry, the Bill could increase them. Not only would there be the additional cost of establishing the scheme, which would add significantly to the fees industry pays to license human medicines—

Mr. Couchman: I touched on that aspect during my speech. Is my hon. Friend saying that he expects that if the Bill reached the statute book the industry would have to pay for that imposition on it?

Mr. Sackville: That would be a matter for discussion. Either way, it would become a burden on industry—directly or indirectly.
There would also be the additional cost, which cannot be estimated but could be very significant, that industry and the Government would face in ensuring the security of commercially sensitive information. The threat of legal challenge should not be underestimated; nor should the

level of open-ended legal costs. In that respect it is worth bearing in mind the experience in the United States, where every year three or four significant judicial reviews are undertaken in the medicines field alone.
As currently drafted, the Bill provides for, among other things, unlimited access to data. There are a number of exclusions, including most products that are under development—although not animal medicines being tested in field trials in food-producing animals. The industry has expressed concern that that will inhibit the research and development work necessary to bring new products on to the United Kingdom market. Details of the manufacturing process itself are also excluded. While those definitions may look straightforward, as has already been said, in practice a good deal of work and difficulty could be involved in identifying the data to be excluded. That could add significantly to burdens on the industry, and to the regulatory authority's costs, which in the United Kingdom, uniquely, are provided entirely by the industry through fees.
The provisions seek to prevent persons with a commercial interest from obtaining sight of data that has been classified as commercially sensitive would surely be open to abuse. The definition of "commercial interest" is so narrow that it would seem to enable those who are prepared to make a living out of buying and selling commercial information to do so, particularly in view of the potential benefits to be gained from obtaining a competitor's confidential data in a multi-million-pound industry.

Mr. Radice: Has the Minister any evidence that such practices have taken place under the pesticides regime?

Mr. Sackville: I have no specific information, but I can imagine the potential scope.
In the United States of America, for example—where freedom of information legislation exists—commercial interests have sprung up to provide competitors with data. The Americans—one can see why—do not think it feasible to try to limit either access to information for those with a commercial interest, or the uses to be made of the data. They take the view that the most practicable approach is to restrict the type of information to be made available, rather than trying—inevitably, unsuccessfully—to restrict the number of people with access, or the use to which it will be put without its being necessary for the competitors to disclose their interest. An obvious benefit of that approach is the reduction of the threat of the legal challenge, which is significant in any event even with those provisions in place.
I know that the industry supports, in principle, the right of patients and animal owners to be more fully informed about the benefits and risks of licensed medicines prescribed for them by their doctors and veterinary practitioners. Currently, the Association of the British Pharmaceutical Industry and the National Office of Animal Health make available data sheets in the form of compendiums, and I know that the Pharmaceutical Association of Great Britain is planning to do the same for non-prescription products. Although those publications are compiled specifically for prescribing practitioners and dispensing pharmacists, they are made available to public libraries and, on request, are sold to individual members of the public via bookshops.
On the human medicines side, I also know that the ABPI is committed to publishing in 1994 a compendium of "user-friendly" patient information leaflets designed essentially to meet the specific needs of patients. I am sure that that will provide very useful information, but although data sheets give a detailed description of the licensed medicine, they cannot give the reason why licensing decisions were taken, the risk/benefit ratio that has applied or data on adverse reactions. For veterinary medicines, the National Office of Animal Health has launched what it calls QEST—pronounced "quest"—initiative to provide user-friendly descriptions of each medicine, including a contribution from the Veterinary Medicines Directorate summarising the pre-licensing assessment.
It is vital to consider the European perspective. Although the European Commission has been asked to consider measures to improve public access to information by the end of 1993, it is becoming increasingly clear that other EC member states are showing little enthusiasm for more openness in the pharmaceutical field. It is argued that the Bill could put us out of step with our EC partners in terms of freedom of information. Even Denmark, which has had a freedom of information Act for some years, does not permit the disclosure of information that it considers to be commercially sensitive; nor does it open its data files to public scrutiny. I shall leave the hon. Member for Durham, North, with his enthusiasm for European matters, to say what he thinks of that, but the point that cannot be underestimated is the potential for United Kingdom applicant companies to choose not only to submit their product licence applications to one of the other European Community regulatory agencies but to make new investment decisions to the United Kingdom's disadvantage. They may not wait until the new EC proposals come into force in 1996.
The Government are committed to making more information available. We are conscious that medicines and medicines control affect the day-to-day lives of virtually everyone in this country and therefore seek to be as open as possible. The Medicines Act 1968 has been seen as providing a virtual block on the making available of relevant information, but that is not entirely true. For example, it provides no bar to the disclosure of information necessary to protect public and animal safety. It must be acknowledged, however that the pharmaceutical industry sends an enormous amount of commercially sensitive data to the licensing authority. This has been protected by the requirements of the Medicines Act and by the common law presumption that confidentiality would be maintained. Information on medicinal products is potentially highly sensitive commercially and there is a risk that without adequate safeguards the provisions of public information could be seriously abused.
The pharmaceutical industry is concerned about the commercial sensitivity of the data that it provides and about the additional burdens that the Bill could place on it and the extent to which it would be taking the United Kingdom out of line with other member states. This is a particularly crucial issue at a time when new EC licensing systems are in the process of being agreed, under which there will be a choice about where medicines licensing business is placed. We should not wish to see the position of the United Kingdom, as the licensing authority or a centre of pharmaceutical excellence, jeopardised.
I said that we do not object to the principles of the Bill. A number of its aspects on more freedom of information in the medicinal licensing field would be beneficial, but we would have difficulty in accepting a number of specific aspects in their present form.

Mr. Ian McCartney: On behalf of the Opposition, I support the Bill. The previous Bill on which my hon. Friend the Member for Durham, North (Mr. Radice) and I worked together was on electricity privatisation, at the end of which he said that one day I would speak from the Dispatch Box. Neither of us thought that the first time that I would do so in this Parliament would be in support of his Bill. It gives me much pleasure to do so.
It is the second occasion in 24 hours that the Under-Secretary and I have faced each other. Yesterday morning, we clashed swords about district health authorities, but, having listened to him this afternoon, I can say that we share more areas of agreement than disagreement on this Bill.
A number of key factors lead the official Opposition, the Liberal party and some Conservative Members to support the Bill, although the hon. Member for Sutton and Cheam (Lady Olga Maitland) adopted a toe-in-both camps approach. I look forward to discovering in Committee which camp she will finally jump into, although I already have a view about that. I shall deal briefly with the objections of the hon. Members for Gillingham (Mr. Couchman), for Basingstoke (Mr. Hunter), for Newbury (Mrs. Chaplin) and for Newark (Mr. Alexander). which fell into three general patterns. I do so because the Under-Secretary and I both represent constituencies in the region that is the heart of the pharmaceutical industry—the north-west. I am a member of the parliamentary pharmaceutical group and have been since I came to the House in 1987. Hon. Members on both sides of the House who support the Bill are not necessarily anti the industry. Indeed, a long-term supporter of the industry and of the development of its product base, its standing in the community and its ability to sell its products should support the Bill and its proposals on the availability of information.
The industry would do itself a disservice if it used the Bill to squeeze the Department and the Minister in its clashes over the pricing policy negotiations with the NHS. It would over-egg the pudding if it used the Bill as such a vehicle, and would also put out the wrong message both to the international community and the British public. For a long time, the British public has been a purchaser of pharmaceutical goods in their billions. That purchasing power of the NHS and the British public has been of the greatest benefit to the development of the industry in the United Kingdom.
Access to information has been denied by the draconian powers of section 118 of the Medicines Act 1968. As the hon. Member for Beckenham (Mr. Merchant) said, that Act was passed by a Labour Government. I am trying to make amends for my forefathers. In the 1960s, 1970s and the early part of the 1980s, legislation from Governments of both parties leant towards curtailing the provision of information to the public. The Bill will enhance the ability of the British people to obtain information that will enable them to take decisions about their daily lives. Much of


British society is blighted by lack of information and secrecy about all aspects of life. That is another basic reason why the Bill should be given a fair wind.
The Bill will remove the blanket secrecy imposed by the pharmaceutical industry. Speeches in the debate have shown us what that has meant in respect of some of the difficulties that have arisen as a result of mistakes. Often, those mistakes have been identified through medical accidents that the provision of information would have prevented.
The Bill will immediately improve the quality of information provided to patients, the clients of doctors, to pharmacists and the veterinary profession. It will enable them to determine the potential risks and benefits of the medicines that we take or those given to animals that eventually end up in the human food chain. It will provide equality of access for national comparisons and for regulation. It is nonsense when United Kingdom companies have to produce information in the United States marketplace that can be looked at by their competitors but that information cannot be looked at by patients, doctors, vets and pharmacists in the United Kingdom. Even if he wished to give us that information, the Minister could not do so. The Bill would rectify that anomaly.
The Bill will improve the equality of access needed to monitor safety and efficacy. All those involved in the health business will want to retain that principle in the whole gamut of health care issues, including the prevention of sickness and the alleviation of illness. That is why it is vital that the Bill is supported not just on the Floor of the House today but in Committee. I hope that no one will table wrecking amendments aimed at preventing the Bill from becoming law. When we know that the Bill is right, we must not take steps in privacy in Committee to strangle the measure and prevent it from reaching the statute book.
The Bill will also develop more rational prescribing regimes and thus benefit doctors, pharmacists and the national health service. That is vital given that on 12 November 1992, the Government indicated in a press statement that negotiations are likely to commence in respect of further restrictions on drugs that doctors can prescribe and increased generic prescribing and negotiations with the industry in respect of the cost to be borne by the NHS for purchasing drugs from United Kingdom manufacturers.
If the Government intend to reduce the amount and type of drugs that general practitioners and pharmacists can prescribe, it is important that when GPs change prescribing patterns they have information to ensure that their decisions are professional in the sense that they can improve and monitor the drugs that they issue and that those drugs benefit the individual to whom they are prescribed.
Little or no academic work has been carried out by the Department of Health into the cost to the national health service of the side effect of drugs since the early 1960s. However, it is commonly accepted that hundreds of thousands of people receive corrective treatment and counselling to regulate the side effects of prescribed drugs. For many unfortunate citizens, that treatment and counselling will continue for many years.
The cost to the national health service is huge while so many of our fellow citizens are restricted by unnecessary and avoidable pain and suffering. The hon. Member for Bournemouth, East (Mr. Atkinson) supported that point and the Bill will seek to address that problem. It will not address the issue completely, but it will be a step on the preventive path to ensure that people are not prescribed individually or collectively drugs that are inappropriate to their condition and which, being inappropriate, cause them years of suffering thereafter. That is another important reason why the Bill should be supported.
I want now to consider the objections to the Bill. In some respects, the objections are legitimate in that no legislation that passes through this Parliament should fail to take account of the effects that it will have on those who need to operate within the constraints of that legislation. Legislation from this place should be the best possible legislation. However, it should not be part of the process of determining that legislation to be frightened off at the outset by interests which do not believe in providing the necessary information to promote the interests of patient care in the United Kingdom.
The objections raised today fell into three basic categories in respect of safeguards for the industry—intellectual property rights, patent product development and retail rights and research and development. All those are outwith the gambit of the Bill. They were all dealt with in two ways.
Intellectual property rights and patent product development and retail rights were dealt with exclusively in the previous Parliament when the Government, with the Opposition's support, provided additional safeguards to the United Kingdom pharmaceutical industry with the patent legislation. Although the industry still believes that the legislation is inadequate, we cannot emasculate this Bill to try to improve product and patent legislation.
If there are problems with patent legislation here, in Europe or in the international context, the matter should come back here and we will examine it and try to improve legislation to ensure that the United Kingdom-based industry is not placed in a difficult position because of trading relationships.
Research and development is very important in the north-west and much of the resources involved in research and development are spent in constituencies like mine. Much of those resources do not arise through a partnership with the Government. Through the pharmaceutical price regulation scheme, the Government take account of the cost of development and production of drugs.
If, in advance of the negotiations, the industry wants more from the negotiations than the Government, the industry should be honest enough to state that. The industry should tell the Government precisely why it believes that the Government are not going to offer a proper deal for its products. However, it must not try to emasculate the legislation in an attempt to put pressure on the Government to give it a far better deal in the negotiations which will soon take place on a price regulation scheme. It is important that the industry gets a return on research and development, but it is also important that it recognises the need to ensure safety and that access to information on product development is available to doctors, pharmacists and the general public.

Mr. Couchman: Does the hon. Gentleman not understand that there is a perception that the Bill is an attack on the industry and that perception will prejudice investment decisions for research and development facilities in this country? Companies from abroad have no need to put their facilities in this country—they have done so for very good reasons, but the Bill will prejudice that situation.

Mr. McCartney: The hon. Gentleman's fears are unfounded. First, as I said, information is already freely available to competitors in the United States and elsewhere. Secondly, companies base their research and development in this country because the product base is excellent and there are massive customers in the form of the national health service and the British public who buy off-the-shelf medicines. We also have a massive work force who are probably the most expert and skilled in Europe; indeed, we are internationally renowned for our skills. Such circumstances could not be replicated outside the United Kingdom, certainly not in the short term, let alone in the long term.
We have a partnership with the industry—it provides research and employment opportunities, but, in return, the United Kindom mark, in the form of the health service and the public, provides it with billions of pounds of resources and a product base which is safe, unlike many of its international markets which come and go. The House will do nothing to undermine the industry's ability to maintain its research and development projects.
The hon. Member for Gillingham is an adviser to Pfizers and also an adviser to the Gin and Vodka Association. I do not know whether that means one has to have a double gin or a bloody mary whenever one takes a tablet from Pfizers, but it is interesting that he is an adviser to the drink and drugs industries at the same time.
There is common ground between our parties on the European evaluation project—I do not want to embarrass the Under-Secretary by repeatedly citing our agreement on it. The Government support the project and a submission from the north-west of England for it to be situated in the Manchester conurbation. Much work has been done to ensure that the project comes to the United Kingdom. It has the full support of the pharmaceutical group in the House, of which I am a member.
The House can be assured that my party will do nothing during the passage of the Bill to undermine the industry's ability to ensure that the project comes to the United Kingdom and that the industry benefits in terms of inward investment and the possible by-product of the sales of products in markets outside the United Kingdom.
The Bill deals with the important consideration of confidentiality and tries to ensure that it is not destroyed and that the levels of disclosure of information are appropriate by ending the blanket secrecy of section 118 of the Medicines Act 1968. The Bill deals exclusively with those issues and does not cover wider issues such as the exclusion of information, which are currently protected by other legislation.
It was wrong of the industry in principle and in tactical terms to cause a misunderstanding about the type of information that the Bill will be able to unlock to the public and the medical profession. Although the notion has been rubbished in some quarters today, it is true that the Safety of Pesticides Regulations 1986 are not a model to compare with this legislation. Let us compare the bulk

expenditure and resources of the pesticide industry with those of the pharmaceutical industry. The issue is not about the purchasing power of each industry. It is about the principle of how information is released in the public domain without damaging or destroying the confidentiality required in the development and research of products prior to distribution in the marketplace. It is not an issue determined by the size of the market. The issue is how the market is developed and how products reach the market. The regulations provide clear guidance—[Interruption.]
My hon. Friend the Member for Bristol, South (Ms. Primarolo) is making it clear that before I sit down, I must commend the Bill. The Bill requires further and adequate consideration, but its principles should commend it to the House. I hope that hon. Members who are worried about the Bill do not take their concerns to the extent of trying to wreck the Bill's chances in Committee. Those outside the House would misread such an action and it would do a disservice to the Government and to their attempts through the White Paper to improve information to patients, to doctors and to the wider community involved in health. For those reasons, I commend the Bill and I believe that it deserves a safe passage through Committee.

Mr. Radice: This has been a debate with many constructive contributions. I congratulated my hon. Friend the Member for Makerfield (Mr. McCartney) on his notable speech at the Dispatch Box. I also congratulate the Minister on a positive contribution on the subject which has helped to put the debate into balance.
There has been general support for the principle of the Bill in the debate—with one or two exceptions—in the sense that most hon. Members agree that section 118 is outdated. The hon. Member for Sutton and Cheam (Lady Olga Maitland)—I refer to her words in an effort to get her on my side—rightly said that section 118 was a suitable case for treatment.
Concerns have been expressed on behalf of the industry about the Bill's impact on it. It is true that the industry is very important—the jewel in our trading crown, as the Minister said. That is why we have gone to such lengths in the Bill to try to safeguard the legitimate commercial innterest of the industry. However, we are also concerned about the safety of medicines and about freedom of information.
What we have tried to do—I believe that we have done it—is not to open up commercial secrets to competitors, as one or two hon. Members have suggested. We are trying to be more open about the safety of medicines and about safety trials. That is the Bill's purpose. Those who say that the Bill will lead to a wholesale plundering of commercial property are exaggerating greatly.
We shall look at all the details of the Bill. We must also consider the Bill in the wider European context. I point out to the Minister that a number of countries are adopting more open systems, so there will be pressure at European level for our Government to take similar action. It would be nice if we were in the lead on one or two issues rather than always opting out or following behind.

Mr. Jeremy Corbyn: I very much support the Bill, so my intervention is not hostile. My hon. Friend must be aware that many doctors have problems in prescribing because of the restrictions on the NHS


prescribing list. Will the Bill assist doctors in finding other medicines as a result of their having better descriptions of the contents of medicines?

Mr. Radice: I will not follow my hon. Friend exactly down that line. All I can say is that doctors will certainly have more information about the safety of drugs because they will be able to find out the reasons licensing authorities give for licensing and for withdrawing licences. That is the basic principle of the Bill.
Despite the criticisms, there is general agreement that section 118 of the 1968 Act is outdated. I even detect a consensus on the idea of publishing summary bases of approval.
If the Bill has faults, as I realise it may, I hope that they can be rectified in Committee. I hope that those who are interested will serve on the Committee so that we can build on the consensus that exists to produce legislation that has the support of the House and the general public and takes into account the legitimate concerns of the industry. I hope that the House will give the Bill its Second Reading.

Question put and agreed to.

Bill accordingly read a Second time, and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).

Licensed Premises (Exclusion of Certain Persons) (Amendment) Bill

Mr. James Hill: I beg to move, That the Bill be read a Second time.
I am sorry to say that we have nearly run out of time. I shall therefore give the shortest possible introduction to the Bill, in the hope that my hon. Friend the Minister will do his best in the remaining few minutes to state the Government's case regarding its provisions.
I introduced the Licensed Premises (Exclusion of Certain Persons) Act 1980—known by publicans as the "Ban the Thugs Bill"—in an endeavour to control unruly villains by excluding them from the pub in which they had misbehaved for a period of, say, one year. The idea was that, if they went into the same pub while the exclusion order was in force, they could be removed by the police.
I am afraid that, for a number of reasons, the implementation of the Act broke down. It was not mandatory on the magistrates—apparently the same probably applies in this case—to use an exclusion order. Although magistrates clerks would have had the information, magistrates themselves apparently lacked it, and there was certainly no overwhelming attempt by the courts to serve exclusion orders. A certain amount of extra paperwork was involved. There was also the question of identification of the person who had been excluded and, if he attended the public house again, of the additional effort that had to be put in by the police to expel or—if he was violent—arrest him.
In 1980, it seemed that the original Act was sufficient, but I am afraid that we have now moved into more violent times. Every day we read in our newspapers of publicans, their staff and their other customers landing in the middle of a fracas simply because the people responsible are uncontrolled.
Perhaps I should tell the House at this point that the National Licensed Victuallers Association is no longer a national organisation. Since the end of 1992 its membership has reverted to regional bodies. That will make it even more difficult for the Home Office to introduce further legislation affecting the vast number of licensed victuallers.
The Bill was drafted hastily. The then NLVA ran out of money to pay the drafting solicitor so I was put in the difficult position of having to try to complete, with the minimum of help, what had already been started. I know that I may not measure up to the high standards of the Home Office in these matters. Nevertheless, the Home Office has kindly said in a letter to me that it will make it possible to send a reminder to the courts, though not anything that will create a priority—

Mr. Jeremy Corbyn: Will the hon. Gentleman give way?

Mr. Hill: I am sorry, but time is too short. The Home Office would send a circular to make the courts aware of what was already enacted in 1980 with regard to the identification of those who had been excluded from public houses. I understand that the police and the licensed trade are already co-operating with the courts.
At one time there was a fear that there would be a sort of rogues gallery in every pub. That was not my intention.


I wanted the photographs, if any, to be put in the staff room or private part of the public house. In that way the public house would not become a rogues gallery.
On the question of where we go from here, I am sure that my hon. Friend the Under-Secretary of State will tell me shortly. I am worried about an article in Justice of the Peace on 27 January 1990 which gave the impression that the 1980 Act was ineffective. I am not sure that that is so. I know that the Lord Chancellor's Department finds it difficult to keep up-to-date figures on the number of exclusion orders which have been issued. Certainly, the emphasis is that, once a magistrate knows about his ability to serve an exclusion order, he is only too delighted to do so because some of the cases that come before the courts are horrifying.
Having said very little, I rely on the sympathy of the House to ensure that the subject does not simply die. I am sure that my hon. Friend the Minister will help me with that.

The Parliamentary Under-Secretary of State for the Home Department (Mr. Charles Wardle): At the outset, I thank my hon. Friend for his clear, helpful and succinct explanation of the background to his Bill and what it seeks to achieve. My hon. Friend is a distinguished parliamentarian and a friend of long standing of the licensed trade. He has made a distinguished contribution to that sector of the economy for many years.
My hon. Friend explained that his purpose in introducing the Bill is to make a number of amendments that have been requested by his friends in the licensed trade and which he and they consider would strengthen the existing provisions of the Licensed Premises (Exclusion of Certain Persons) Act 1980. He also seeks to make it a more effective response to the problem of violence on licensed premises.
The 1980 Act, which my hon. Friend played such a significant part in placing on the statute book, gives the courts a particular power to use against anyone convicted of a criminal offence which occurred on licensed premises and involved the use, threat or offer of violence. At its discretion, and in addition to any other sentence it imposes, a court may make an order prohibiting such an offender from entering any licensed premises it chooses to specify for between three months and two years without the express consent of the licensee or his staff.
A person who enters licensed premises in breach of such an order commits a fresh criminal offence which is punishable by a fine of up to £1,000 or imprisonment of up to a month, or both. A licensee is entitled to expel such a person from his premises and may demand the assistance of the police to do so.
I turn now to the detailed provisions of my hon. Friend's Bill. Clause 1 requires a court to consider making an exclusion order in all appropriate cases. It will give a court the power to provide that an exclusion order should apply to all licensed premises within a specified area—most commonly a licensing district—and make it clear that a licensee's consent to an excluded person entering his premises will be effective only if it is given in full knowledge that the person involved was the subject of an exclusion order.
Originally, it was my hon. Friend's intention that his Bill should require a court to make an exclusion order,

applying at least to the premises in which the offence occurred, in every case where someone was convicted of a relevant offence. That would have been wrong in principle. It must be for the courts alone to determine whether to make an exclusion order in a specific case in the light of all the circumstances of the offence and the information pertaining to the offender. My hon. Friend is now prepared only to require the courts to consider making an exclusion order in relevant cases. However, it is unclear what that would achieve in practice. Courts are already expected to consider all the sentencing options at their disposal for a particular offence before passing sentence and they have their clerks to advise them in such matters. Therefore, the new provision seems unnecessary.
Similarly, given that the 1980 Act already places no limit on the number of premises from which a court may exclude an offender, we see no pressing need to amend the statute to provide that offenders may be excluded from all licensed premises in a designated area. Neither are we persuaded that there is any particular pressing need for the consent provision in this Bill.
My hon. Friend and his supporters have told us that not all courts appear to be readily aware of their powers under the 1980 Act and that too little use is made of it generally. I can tell the House that, to meet those concerns, we are certainly prepared to consider a fresh reminder to the courts about the 1980 Act. However, I must stress that any such advice could take the form only of a reminder of the powers that that Act gives to the courts. We cannot give the courts directions as to the sentence to impose in any particular category of case, as I know that my hon. Friend will appreciate.
The main purpose of clause 2 is to make the simple breach of an exclusion order an arrestable offence. This is objectionable in principle and disproportionate to the mischief concerned. Under the Police and Criminal Evidence Act 1984, the power to arrest without warrant usually exists only where the maximum penalty for an offence is five years' imprisonment or more. The present maximum custodial penalty for simple non-compliance with an exclusion order is one month's imprisonment.
The position may, of course, be different if another offence is committed at the time in question or if the offender resists expulsion. The police might then be able to arrest the offender either on account of the other offence, or for obstructing a police officer in the execution of his duty. Any breach of the peace or public nuisance could also lead to an offender being arrested.
To make a simple breach of an exclusion order an arrestable offence would also be likely, in our view, to be of limited practical value. Since there would be no grounds on which an offender could be detained once he or she had arrived at the police station, they would normally quickly be charged and bailed and thus free, if they so chose, to return to the premises concerned almost immediately— back to the pub, as it were.
My hon. Friend and his supporters also believe, I understand, that to make a simple breach of an exclusion order arrestable would also, indirectly, bring about a greater number of prosecutions for breaches of such orders. This seems to us unlikely. The decision whether to prosecute an individual ultimately rests with the independent Crown prosecution service, rather than with the police.
As for clause 4, we do not believe that primary legislation, again including powers of arrest without


warrant, is necessary to establish a scheme to secure the attachment of the photographs of excluded persons to exclusion orders. We readily accept the argument that to do so would enable licensees and their staff, particularly those unconnected directly with the offence that led to the imposition of the order, better to identify any excluded persons who might enter their premises in breach of an order. But we believe that this objective can, broadly speaking, be achieved administratively and, as my hon. Friend and his supporters are aware, we have already given some consideration to the ways in which this might be done. It is a valuable point.
In this context, there is justifiable concern that any photographs which it may prove possible to provide to licensees for this purpose should be treated with due care and attention. They ought not, in our view, to be publicly displayed for all to see, including customers. We believe that the best way to tackle this issue is to bring together representatives of the police and the various licensed trade organisations to discuss drawing up a voluntary code of practice and this we intend to do. I am grateful that my hon. Friend has prompted the Government in that regard.
I recognise that most—but, I hope, not all—of what I have said will come as a disappointment to my hon. Friend and his supporters in the licensed trade. I have to tell the House, however, that successive Home Office Ministers have made clear their attitude to these particular proposals, both in letters and at meetings over a fairly long period. It is not that we in any way condone or take a soft attitude to violence on licensed premises. We view it very seriously indeed and would expect the courts to do the same. At the same time, however, we believe that the particular changes to the 1980 Act that the Bill seeks to introduce are, as I have explained to the House, either wrong in principle, simply unnecessary, or achievable by other means short of primary legislation.

Mr. Roger Knapman: I am grateful that I managed to catch your eye, Madam Deputy Speaker. The news that I was to address the mother of Parliaments has obviously travelled widely, as shown by the prayer cards that have been put in position for these Friday debates.
I congratulate my hon. Friend the Member for Southampton, Test (Mr. Hill) on his success in the ballot and on bringing the Licensed Premises (Exclusion of Certain Persons) (Amendment) Bill to the House. He is a senior and respected Member and has a long success list under the private Members' Bill procedure. As he said, he was largely responsible for the Licensed Premises (Exclusion of Certain Persons) Act 1980, which the Bill seeks to amend.
I am sure that we are also grateful that my hon. Friend the Under-Secretary of State, Home Department is on the Front Bench. He stated the Government's position with his usual clarity, which was well matched by the clarity and precision of the letters that he and his staff have sent to all his Back-Bench colleagues, which is a lesson to one or two, but I shall not say which one or two.
That is the end of the good news for a few minutes because all future legislation will be subject to a little-known procedure—the Roger Knapman reduction of legislation regulations. They have not gone through the House formally but will mean that every time 10 Bills reach the stage of Royal Assent we shall have a debate to decide which Bill is the best and should proceed. In the unlikely event of a Labour Government, it will not be 10 Bills but 100; where the European Parliament is concerned, it will have to be one in 10,000, but we can usually manage that in a normal day.
The Bill has serious subject matter. I do not doubt that in some areas there is violence on licensed premises and I imagine that that is true in Stroud, Southampton and many other parts of the country.
I think that my hon. Friend the Member for Test will agree that he is seeking to ensure—as we all are—that the police, publicans and everyone else is protected from violence in such circumstances. I was interested to read the article about my hon. Friend and his Bill in the Morning Advertiser on 16 December, although I am not a regular subscriber to that paper. As well as a description of the Bill, that issue contained two articles entitled, "Gun law anger" and "Pubs caught in orgy of terror". My hon. Friend therefore does the House, the public and the trade a service by introducing the Bill.
My hon. Friend the Minister has already made his views on the issues fairly clear, but I wonder whether he could agree with my first general point, that it is essentially for the courts alone to determine whether to make an exclusion order in any particular circumstance, because the circumstances of both the offence and of the offenders must vary from place to place.
My hon. Friend the Member for Test touched on two of the Bill's main amendments to the original Act. Am I right in thinking that the first amendment would require the courts to consider making an exclusion order in all relevant cases?
I look forward to studying the record because it is not yet clear to me what the new provision would achieve in practice. Am I right in thinking that the courts are already required to consider all sentencing options for an offence at their disposal before passing sentence?

Mr. Michael Stern:: My hon. Friend has hit on a major concern about the drafting of the Bill, however laudable its general aim. If we start to tell courts to consider one sentencing option as opposed to another in a particular case, we shall inevitably face demands from pressure groups and interested bodies to consider other sentencing options in other cases or even the same case. I speak with the experience of being married to someone who has just gone through training as a magistrate. Ultimately, the courts will be presented with so many options in so many cases that we shall negate the entire procedure.

Mr. Knapman: As my hon. Friend lives in Bristol and I do not live far away, I hope to meet his wife, but not on the conclusion of her training. The point that he makes is precisely the one that I should have wished to make—

It being half-past Two o'clock, the debate stood adjourned.

Debate to be resumed upon Friday 29 January.

Private Members' Bills

EUROPEAN UNION (PUBLIC INFORMATION) BILL

Order for Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday 22 January.

OCCUPATIONAL PENSIONS BILL

Order fir Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday 22 January.

DISABLED PERSONS (SERVICES) BILL

Order for Second Reading read.

Madam Deputy Speaker (Dame Janet Fookes): Second Reading what day? No day named.

ELIMINATION OF POVERTY IN RETIREMENT BILL

Order for Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday 5 March.

PRIVATISATION OF GIPSY SITES BILL

Order for Second Reading read.

Madam Deputy Speaker: Second Reading what day? No day named.

GAS (EXEMPT SUPPLIES) BILL [LORDS]

Read a Second time.

Bill committed to a Committee of the whole House. —[Mr. Duncan.]

Bill immediately considered in Committee; reported, without amendment.

Motion made, and Question, That the Bill be now read the Third time, put forthwith pursuant to Standing Order No. 75 (Third Reading), and agreed to.

Bill accordingly read the Third time, and passed, without amendment.

SLAUGHTERHOUSES BILL

Order for Second Reading read.

Hon. Members: Object.

Second Reading deferred till Friday 22 January.

DAMAGES (SCOTLAND) (No. 2) BILL [LORDS]

Ordered,

That the Damages (Scotland) (No. 2) Bill [Lords], now standing committed to a Committee of the whole House, be committed to a Standing Committee.—[Mr. Wilson.]

Private Nursery Schools

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Mackay.]

Mrs. Teresa Gorman: I welcome this opportunity to bring to the attention of the House the difficulties that are experienced by tens of thousands of small children throughout the country, their parents, and those who run play groups and nursery schools. It could reasonably be said that I want to talk about kiddie care being clobbered by callous councils.
Since the Government introduced new regulations applying to the Children Act 1989, there has been chaos in many parts of the country in which decent, nice, friendly mums and housewives and others run facilities for young children—particularly those aged between three and five. That is largely a voluntary activity. If done privately, it is often run on a shoestring, with few resources, thanks to the good will and tender loving care of those who take an interest.
There are thousands of private schools, and since the regulations became effective in October 1991 they have driven many of the people who run such schools crazy. Some are being forced to close down because they cannot afford to meet the new regulations. I am not blaming the 1989 Act or even the Government—although they introduced the regulations that qualified that Act to some extent.
The Government introduced guidelines that local authorities were meant to adopt with discretion and common sense, but they provided an opportunity for many social service departments to go absolutely crazy in demanding standards that are completely inappropriate and much too expensive.
When it comes to dealing with young children, one would think that, above all, a delicate touch would be needed. Instead, the typically heavy hand of bureaucracy is swiping them around the head. I know that my hon. Friend the Minister issued a direction to local authorities to lay off and to apply the regulations more sensibly, but the evidence reaching me does not suggest that his advice is being taken.
I want to reinforce the view that my hon. Friend the Minister has already taken—that local authorities must be made to be sensible. The Government would do better to withdraw the regulations, on the ground that there was never any great need for them in the first place. Nowadays, there are no examples of great abuse. Where abuse occurs, unfortunately it is in public sector nurseries and other organisations, in which highly qualified people in regulated premises still manage to run schools badly. Given the size of the semi-voluntary industry, it is extraordinaty how few complaints are made.
All child minders, nurseries, and nursery schools were required to be registered before the regulations were introduced, but the regulations require them to pay a licensing fee of £100. That is a lot of money to three or four mothers who are not doing it for the cash. There is also a fee of £75 payable for an inspection according to a new set of guidelines. That is where the trouble starts.
It is a good example of people being forced to pay for the rope that is used to hang them. As the regulations arrived at town halls, social service department busybodies called on all the little schools—many of them in private


homes and village halls—and laid down the law. It gives me no pleasure, although perhaps some pride, to remind the House that I warned of that as a member of the Committee that considered the regulations. To their credit, many women Labour Members, who understood the reality of the situation, joined in my criticisms. Now that the regulations have been introduced, we must do something about them.
There is a huge difference between facilities resourced by the public sector—where money is often regarded as a bottomless pit—and those that are run on a shoestring, on a non-profit making and informal basis, by the private sector.
As I have said, the cost of registration and inspection is enough to cause problems. If I want someone from the gas board to spend an hour in my house inspecting the cooker, I am charged £20; if my premises had to be inspected under these regulations, I would be charged £75. That is only the beginning, because it is almost inevitable that something will be found to be wrong with the average domestic premises used for such purposes.
The guidelines contain standards relating to the space allotted to each child. They also contain regulations concerning sanitary facilities, staff ratios and the fitness or otherwise of the women—they are mostly women—who run such schools. In charge of making the necessary judgments are social workers, many of whom have no relevant experience and, indeed, are not formally qualified themselves. That is wholly inappropriate.
There are howling discrepancies in the staffing ratios. If a school is described as a nursery, it must have a ratio of one member of staff to five children; if it is described as a nursery school, the prescribed ratio is one to 13. Schools given other descriptions are required to have different staff ratios. Yet all the children attending such institutions are in the same age group: they are between three and five years old. That is ridiculous.
Nearly all the women who run the schools are experienced parents. Almost all have no formal qualifications, but they are told that they must acquire such qualifications or pay a qualified person. Paying a qualified person will of course cost money, and the fees will therefore have to rise; hardship cases—parents who can barely afford to pay £5 a morning for their children to attend nursery school—will be worst hit. The schools are not backed by charitable institutions that will find the money for those hardship cases, and mothers who may have to pay for several small children are driven away.
If a woman is forced to take a training course, she may have to travel some distance from home one day a week. She may have children of her own whom she cannot leave; if she manages to attend such a course, she will be instructed by some young person who will give her a formal description of common-sense practices that are second nature to a mother who regularly deals with small children. Telling such women about toilet training and tying shoelaces is almost an insult. A wholly inappropriate set of qualifications are being applied where they are not needed—and gaining such qualifications costs money.
The number of staff can vary enormously; so can the sanitary facilities. Most of the schools are in private homes, which will have a normal-sized loo and washbasin and a towel on the wall. Many others are in church halls,

which are designed largely for adult use: the same conditions will apply there. Then along comes an inspector from the social services department, demanding that mini-loos be installed. Mini-loos cost a fortune—about £150—while an ordinary toilet can be picked up for £25. Mini-loos must be specially plumbed; they must be accompanied by mini-handbasins, mini-clothes pegs and mini-hand dryers—the children are not allowed to share a hand towel. No such conditions apply when the children are in their own homes, and, indeed, it is surely sensible to train them to climb onto a box step to use the toilet. After all, that is what they do at home.
Those requirements are not obligatory. I am sure that my hon. Friend the Minister will tell me that the authorities are being over-zealous, but the women who run the schools do not know that; they feel that such action is demanded of them, and it is often for that reason, if for no other, that they decide to stop running schools in the premises that they have been using.
Some schools are being told that their outside play areas are unsatisfactory. The regulations call for soft surfaces such as grass and for areas to be fenced and gated. It is absurd to say that all these measures must be enforced. Sometimes a village hall will be surrounded by tarmac, which is perfectly all right for childen to play on if they are supervised, but schools are being told that they must have a soft play area or the children cannot go outside. In the summer, they must remain indoors. Any sane and normal person would think that that is another ridiculous requirement.
Most of the schools are run by women who have plenty of common sense and will not subject the children to danger. Schools are often held in an old village hall and those who run them are being told to install double glazing with shatter-proof glass, extra double ceilings, special curtains and more exits. People say that these schools should be safe, but they have not been unsafe for 25 or 30 years and will not suddenly become unsafe overnight. There have been examples of the fire inspector declaring a hall to be perfectly adequate but the social services officer saying that it is not. The many regulations mean that little schools can no longer afford to charge a price that parents can afford.
I agree with the Minister that quality is important, but that does not necessarily mean qualifications. It might mean common sense, experience and tender loving care —those are the qualities necessary in education, particularly for small children. Someone who has diplomas and certificates can be a complete idiot. Ten qualified people looking after a dozen children can create more chaos than three or four experienced mothers who know how to handle children and have been doing so for a long time. I do not deny that we want quality, but it cannot necessarily be qualified formally.
I discussed the problem with the Child Care Association, a voluntary body to which many private sector schools belong. The southern counties directory of day nurseries runs to 500 pages, which shows the size of this voluntary industry: it is big business. The association's secretary, Susan Hays, has had meetings with Baroness Seear in the Lords, who takes an interest, and with my right hon. Friend the Secretary of State for Health who takes an interest and is a mother herself. The association wants to do all the right things. It is not asking to be let off the hook but to have the regulations withdrawn.
My complaint is about not the Children Act but about the additional regulations that are being handled so badly. Heather Armstrong has been running a school in Orsett in my constituency for about 20 years. It is held in a typical old church hall building about half the size of the Chamber. It has three exits and 25 children attend four mornings a week. Heather Armstrong has three helpers who have been there 12 years or more. Those four experienced women have no paper qualifications. Along comes the woman from social services, who tells them that all the door handles must be raised to a point where the children cannot possibly open the door and run out. She tells them to install minature loos for boys and girls, basins, hand driers and little pegs. The village hall will not put up the money, and if the school is to do so it will have to raise £3,000 or £4,000. It charges £5 a session and the women draw £10 a day. It is charged £9 a day for the use of the village hall. That is the financial level with which we are dealing. It allows people in the village who are not well off and who have many children to use those much-loved, much-respected and much-needed facilities.
Now, the school has been told that the village hall authorities cannot implement all the regulations—there are others involving heating, play facilities out of doors and so on—so it will have to leave. After 20 odd years of being there, the school is being thrown out. The only other village hall has windows that are floor to ceiling and if the school uses that hall, the windows will have to be replaced with "shatter-proof" glass or the children must be corralled inside a fence in the hall so that they are nowhere near the windows. The whole thing is absurd.
Here we have a village with a much-loved little school, supported by the local people, having to raise £30,000 or more to build a facility. That is nonsense. It is not good enough and I am sure that the Minister did not intend it, but those women are now being told that they are running the school illegally and are liable to prosecution. What kind of a country do we have when silly regulations turn decent people, doing a sensible and useful job, into criminals?
That is one example, but there are others. Another woman who runs a nice nursery school has been told that all her ceilings must be double plasterboarded. Again, the school is run in a little hall and she has been told that she must have new emergency lighting, which will require the rewiring of the whole building. She must have additional fire doors put in, although there are more than adequate exits already. She has to have more partitions put up between toilets and she has to put in extra toilets. All those requirements and more are being demanded before she can get her school approved under the new regulations and she says that she has had in the authorities, including the fire inspector, who says that the facilities are not required. In the end, she has put the matter in the hands of a solicitor.
A woman in Wallsend has applied for registration under the new regulations. She recently borrowed money from the bank to expand the facilities and to take in more children, but she now faces bankruptcy because she car not do so. I could go on giving names and examples from all around the country of people being driven mad for trying to perform a useful service to our community.
My right hon. Friend the Prime Minister has expressed his concern about regulations and his determination that unnecessary regulations should be done away with because of their effects. He says that he will not put up with it and I believe him. I understand that he is having a meeting at

Chequers next weekend. He might like to invite me down there so that I can give him good examples of regulations going mad. That example will be top of my list. I know that I can rely on my hon. Friend the Minister to put the case for me, and to do something to rescue those admirable activities from the dead weight of the state. The effects will not stop unless he intervenes.
It is no good hoping that the councils will take a more lenient view—they will not. Give a bureaucrat a regulation and he will stick to it like a leech. He will keep applying that leech to that little body of people doing a useful job until it sucks them dry. I know that the Government want to expand such facilities, to get rid of unnecessary obstructions and to reduce the effect of regulations. Here is an excellent opportunity for them to make a start. By and large, the problem will be solved not by qualifications but by common sense. We must support those who are prepared to give their time to do a useful job and who should be supported all along the way.

The Parliamentary Under-Secretary of State for Health (Mr. Tim Yeo): I congratulate my hon. Friend the Member for Billericay (Mrs. Gorman) on securing this debate on such an important subject in the very week the Department of Health published its further guidance on the Children Act 1989 and day care services. I greatly appreciate my hon. Friend's characteristically colourful approach to the subject and her descriptions of the problem. Although with perhaps just the occasional hint of over-statement, she made a very powerful case.
My hon. Friend's application for this Adjournment debate was made before we issued our circular, which includes many important messages including some relating directly to the concerns expressed so eloquently by my hon. Friend. Although the circular contains many important messages, I am not sure whether my hon. Friend has had a chance yet to read it from cover to cover. I can assure her that there are no references to such things as the need for soft furnishings or soft floor coverings in play areas. I am not sure where my hon. Friend obtained her information about that.
I am happy to follow up specific cases where it appears that local authorities have taken decisions that clearly contravene our guidance. Where schemes have been refused registration, I hope that they have exercised their opportunity under the legislation to appeal against the imposition of unreasonable requirements on registration.
It is true that we have become more concerned about the rigid and unhelpful way in which some local authorities have applied the Children Act 1989. As my hon. Friend has said, we are very proud of the enormous and vital contribution that the private and voluntary sectors make in providing child care. We are also very proud of the huge army of child minders. We want those services to flourish and grow. Everyone, including parents with working commitments, must see that they can take advantage of the growth in services.
We also want acceptable standards in the facilities, and that must involve some form of statutory regulation. However, as we have made clear, it must be regulation with a light touch. There must be a framework which encourages people to set up services. We are afraid that


some local authorities are creating too many bureaucratic hurdles which hinder expansion and may even reduce provision. We certainly do not want that to happen.
The legislation provides a sound basis for regulating day care services and it is possible for them to flourish against that background. However, the law perhaps enables some local authorities to be over-rigid and unhelpful. Although we do not believe that the law itself is unhelpful, we have revised the guidance that we issued only a year after the Children Act came into force.
The law requires local authorities to decide whether someone applying for registration is fit to look after children aged under eight and that their premises and equipment are also fit. That concept demands a flexible approach. It most emphatically does not prescribe qualifications or conditions that an applicant must meet before being registered. The Act does not prescribe standards for particular services.
We recommend that the staff-child ratios which are often quoted in connection with representations on such matters are the same for nursery schools as for maintained schools and classes. As my hon. Friend said, they are lower than those for day care facilities. They allow larger groupings than those recommended for day care settings because the hours of operation are shorter in a school than in a nursery, which may operate from 8 am to 6 pm.
The problem is that some—though not all—local authorities have been applying the Department's guidance too rigidly. That is clear from my correspondence. I have met people who run playgroups and day nurseries. I have also met child minders, and I have received representations from parents concerned about the possibility that their children might not have a service to attend. Some providers and child minders are apparently being told that they must spend a lot of money on new furniture or equipment, which might put them out of business. In some cases, the registration officer has not appeared to give proper recognition to the skill and experience of the person who has, sometimes for many years, offered a good service to children and a service with which parents were wholly satisfied.
We did not believe that the situation could be left to settle on its own because there was a risk that some services would close altogether—it was not merely a case of the teething problems that one would expect with new legislation. That is why we issued the circular.
The circular has five main messages. First, the Government wish to encourage an expansion of day care services of an acceptable standard. Secondly, the wording of the legislation presupposes that applicants will be granted registration unless the local authority has one or more positive reasons for refusing it. Thirdly, our guidance does not prescribe legally required standards for registration. Fourthly, the guidance draws attention to factors that local authorities need to consider when deciding about registration. Fifthly, local authorities

should use their own perception of local need in addition to our guidance when deciding whether to register a particular facility. Finally, the circular states that the guidance has been applied over-strictly by some authorities, which have insisted on even higher standards than those suggested but without any justification for such a demand.
The key message in the circular is that the particular standards recommended in the Children Act guidance are not prescriptive. They are common factors which we think are relevant to deciding that someone is fit to look after young children. They should be used as points of reference, but not applied rigidly. We have reminded local authorities that registration should not be refused merely because, for example, there are not enough lavatories or because the facility does not comply in every respect with recommended space standards. Facilities that fail to meet those two requirements may in other respects be perfectly capable of providing an acceptable quality of care. I cannot stress to my hon. Friend too strongly that all local authorities must examine each case separately on its merits and must base decisions on an overall assessment of each application for registration.
As for private nursery schools, we have just issued a circular that tells local authorities to adopt a lighter touch to registration generally. It is fair for us now to wait and see how it works in practice before we rush to make further judgments about what may be needed.
The current problems with the registration of day care services was not caused, therefore, by the Children Act itself. What was wrong—I think that my hon. Friend was making the same point—was the way some local authorities applied the legislation and the use that they made of the guidance issued jointly by the Departments of Health and Education. The standards recommended in that guidance seem to have been treated as having a prescriptive force and to have been applied sometimes in an unhelpfully rigid manner. That does not help the expansion of day care services, which is what we want to achieve—with the voluntary and private sectors in the vanguard of that process—and it is especially unhelpful to the private day care sector, which we expected to be leading the expansion process.
The circular that we published on Monday this week will remove many of the difficulties experienced by my hon. Friend and her constituents and by people elsewhere in the country. Nevertheless, I undertake to keep a close watch on the issue, and we shall not hesitate to take further action against local authorities that continue to work in a rigid and unhelpful way.
On the narrower subject of private nursery schools and the Children Act, I will ensure that the House is kept informed about the discussions that we are having with the Department for Education about any appropriate changes that may be needed to the regulation of such schools.

Question put and agreed to.

Adjourned accordingly at three minutes past Three o'clock.